Provider Demographics
NPI:1215290754
Name:SMITH, KANDIS ALEXIS (DMD, MA)
Entity type:Individual
Prefix:DR
First Name:KANDIS
Middle Name:ALEXIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 NEWPORT AVE APT 612
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2661
Mailing Address - Country:US
Mailing Address - Phone:857-294-6168
Mailing Address - Fax:
Practice Address - Street 1:690 DEPOT ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-2700
Practice Address - Country:US
Practice Address - Phone:508-238-2924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856022122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist