Provider Demographics
NPI:1649700717
Name:SMITH, SCOTT STEVEN (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:STEVEN
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 1:15807 ROBINS WAY
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-7454
Mailing Address - Country:US
Mailing Address - Phone:801-529-6121
Mailing Address - Fax:
Practice Address - Street 1:518 N GENERALS BLVD STE F
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3537
Practice Address - Country:US
Practice Address - Phone:704-748-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice