Provider Demographics
NPI:1982172433
Name:SMITH DENTAL CARE OF ATHENS INC.
Entity Type:Organization
Organization Name:SMITH DENTAL CARE OF ATHENS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-389-1301
Mailing Address - Street 1:259 ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-1854
Mailing Address - Country:US
Mailing Address - Phone:706-376-2345
Mailing Address - Fax:
Practice Address - Street 1:801 US HIGHWAY 29 NORTH
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601
Practice Address - Country:US
Practice Address - Phone:706-389-1301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherGENERAL