Provider Demographics
NPI:1285375592
Name:SMITH, DANIEL PHILLIP (DMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PHILLIP
Last Name:SMITH
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4575
Mailing Address - Country:US
Mailing Address - Phone:706-632-2085
Mailing Address - Fax:
Practice Address - Street 1:823 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4575
Practice Address - Country:US
Practice Address - Phone:706-632-2085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-02
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1229821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice