Provider Demographics
NPI:1972673168
Name:SMITH, DOUGLAS G (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 CHAPMAN HWY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-5044
Mailing Address - Country:US
Mailing Address - Phone:865-579-3368
Mailing Address - Fax:865-579-3369
Practice Address - Street 1:11550 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5044
Practice Address - Country:US
Practice Address - Phone:865-579-3368
Practice Address - Fax:865-579-3369
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 41851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN641244OtherUNITED CONCORDIA PROV. ID
TN0058491OtherBCBS PROVIDER ID