Provider Demographics
NPI:1245444595
Name:SMITH, DEE G (DMD)
Entity type:Individual
Prefix:DR
First Name:DEE
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-9133
Mailing Address - Country:US
Mailing Address - Phone:270-422-4715
Mailing Address - Fax:
Practice Address - Street 1:5912 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:FERN CREEK
Practice Address - State:KY
Practice Address - Zip Code:40291-1957
Practice Address - Country:US
Practice Address - Phone:502-239-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY83751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice