Provider Demographics
NPI:1124132972
Name:SMITH, PATRICK C (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:C
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 1:13901 US HIGHWAY 1 STE 9
Mailing Address - Street 2:
Mailing Address - City:JUNO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-1612
Mailing Address - Country:US
Mailing Address - Phone:561-694-9000
Mailing Address - Fax:561-694-9001
Practice Address - Street 1:13901 US HIGHWAY 1 STE 9
Practice Address - Street 2:
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1612
Practice Address - Country:US
Practice Address - Phone:561-694-9000
Practice Address - Fax:561-694-9001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL108361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice