Provider Demographics
NPI:1285061150
Name:STEVEN F, SMITH, D.D.S., MARK C. SMITH, D.D.S.
Entity type:Organization
Organization Name:STEVEN F, SMITH, D.D.S., MARK C. SMITH, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-623-7116
Mailing Address - Street 1:305 COSBY HWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-2914
Mailing Address - Country:US
Mailing Address - Phone:423-623-7116
Mailing Address - Fax:423-623-5743
Practice Address - Street 1:305 COSBY HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2914
Practice Address - Country:US
Practice Address - Phone:423-623-7116
Practice Address - Fax:423-623-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS40161223G0001X
TNDS42291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1225103088OtherGENERAL DENTISTRY
TN1881770006OtherPEDIATRIC DENTISTRY