Provider Demographics
NPI:1124151345
Name:SMITH, ANDREA M (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 EDGEWOOD PARK CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4392
Mailing Address - Country:US
Mailing Address - Phone:901-490-6889
Mailing Address - Fax:
Practice Address - Street 1:1400 DALE BUMPERS DR
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2695
Practice Address - Country:US
Practice Address - Phone:870-494-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78491223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health