Provider Demographics
NPI:1669573887
Name:SMITH, JAMES KEITH (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KEITH
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1777 LEE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-3073
Mailing Address - Country:US
Mailing Address - Phone:770-948-1600
Mailing Address - Fax:770-948-4374
Practice Address - Street 1:1777 LEE RD
Practice Address - Street 2:SUITE D
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3073
Practice Address - Country:US
Practice Address - Phone:770-948-1600
Practice Address - Fax:770-948-4374
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0111181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice