Provider Demographics
NPI:1831153451
Name:SMITH, JOHNNY SHELDON (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:SHELDON
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 COUNTRY PL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-4042
Mailing Address - Country:US
Mailing Address - Phone:901-466-0597
Mailing Address - Fax:901-466-1581
Practice Address - Street 1:7066 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-4042
Practice Address - Country:US
Practice Address - Phone:901-466-1580
Practice Address - Fax:901-466-1581
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000048901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice