Provider Demographics
NPI:1285353169
Name:SMITH, SARAH MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 PARK ST APT 311
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-5529
Mailing Address - Country:US
Mailing Address - Phone:727-692-7245
Mailing Address - Fax:
Practice Address - Street 1:138 COUNTRY CLUB CT
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3704
Practice Address - Country:US
Practice Address - Phone:727-937-5159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL274861223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice