Provider Demographics
NPI:1154394518
Name:SMITH, DONALD CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CHARLES
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 1:4605 LAUREL SPRING CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-6757
Mailing Address - Country:US
Mailing Address - Phone:804-768-2295
Mailing Address - Fax:
Practice Address - Street 1:4605 LAUREL SPRING CT
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-6757
Practice Address - Country:US
Practice Address - Phone:804-768-2295
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010097921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice