Provider Demographics
NPI:1689125213
Name:SMITH, NATALIE R (DDS)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 LAKESHORE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1748
Mailing Address - Country:US
Mailing Address - Phone:523-591-5253
Mailing Address - Fax:
Practice Address - Street 1:1175 PEACHTREE ST NE STE 1202
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30361-3543
Practice Address - Country:US
Practice Address - Phone:404-874-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16028122300000X
MND138831223S0112X
GADN1230381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist