Provider Demographics
NPI:1932390481
Name:SAMUEL IRBY SMITH DDS PA
Entity Type:Organization
Organization Name:SAMUEL IRBY SMITH DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:IRBY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-449-0700
Mailing Address - Street 1:1001 S CROATAN HWY
Mailing Address - Street 2:PO BOX 7429
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-8706
Mailing Address - Country:US
Mailing Address - Phone:252-499-0700
Mailing Address - Fax:252-449-0706
Practice Address - Street 1:1001 S CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-8706
Practice Address - Country:US
Practice Address - Phone:252-499-0700
Practice Address - Fax:252-499-0706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMUEL IRBY SMITH DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-08
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910814Medicaid
NC8997948Medicaid