Provider Demographics
NPI:1932269271
Name:SMITH, WILLIAM CARLOS JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CARLOS
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:
Other - Last Name:SMITH DMD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:128 E CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9795
Mailing Address - Country:US
Mailing Address - Phone:803-359-2488
Mailing Address - Fax:
Practice Address - Street 1:3244 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3428
Practice Address - Country:US
Practice Address - Phone:803-794-0146
Practice Address - Fax:803-796-1974
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice