Provider Demographics
NPI:1881967263
Name:SMITH, MARK STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
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 1:7685 WOLF RIVER CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1749
Mailing Address - Country:US
Mailing Address - Phone:901-767-4882
Mailing Address - Fax:
Practice Address - Street 1:7685 WOLF RIVER CIR STE 102
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1749
Practice Address - Country:US
Practice Address - Phone:901-767-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 332261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice