Provider Demographics
NPI:1215951132
Name:SMITHA, DONALD L (DDS, MDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:SMITHA
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 ALDERMAN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-6102
Mailing Address - Country:US
Mailing Address - Phone:904-725-8282
Mailing Address - Fax:904-725-7197
Practice Address - Street 1:812 ALDERMAN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-6102
Practice Address - Country:US
Practice Address - Phone:904-725-8282
Practice Address - Fax:904-725-7197
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 58021223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT 55259Medicare UPIN
FL86023YMedicare ID - Type Unspecified