Provider Demographics
NPI:1063437705
Name:SMITH, PAUL B (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4006 SAINT CLAIR CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1847
Mailing Address - Country:US
Mailing Address - Phone:404-728-7612
Mailing Address - Fax:404-728-5065
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:DENTAL SERVICE (160)
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-728-7612
Practice Address - Fax:404-728-5065
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0083861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice