Provider Demographics
NPI:1942356324
Name:SMITH, STEVEN J (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 HOWLAND BOULEVARD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738
Mailing Address - Country:US
Mailing Address - Phone:386-574-7272
Mailing Address - Fax:386-574-5052
Practice Address - Street 1:1382 HOWLAND BOULEVARD
Practice Address - Street 2:SUITE 104
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738
Practice Address - Country:US
Practice Address - Phone:386-574-7272
Practice Address - Fax:386-574-5052
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist