Provider Demographics
NPI:1215048608
Name:SMITH, DENNIS C JR (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:C
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:410 CELEBRATION PL STE 401
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5436
Mailing Address - Country:US
Mailing Address - Phone:407-303-3820
Mailing Address - Fax:407-303-3821
Practice Address - Street 1:410 CELEBRATION PL STE 401
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5436
Practice Address - Country:US
Practice Address - Phone:407-303-3820
Practice Address - Fax:407-303-3821
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048085208600000X, 2086S0127X
FLME121941208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E84701Medicare UPIN
GA02BBGHBMedicare PIN