Provider Demographics
NPI:1336108406
Name:SMITH, DAVID P (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BENNETT RD
Mailing Address - Street 2:P.O. BOX 620
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-5005
Mailing Address - Country:US
Mailing Address - Phone:865-435-4100
Mailing Address - Fax:865-435-1771
Practice Address - Street 1:102 BENNETT RD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-5005
Practice Address - Country:US
Practice Address - Phone:865-435-4100
Practice Address - Fax:865-435-1771
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS42041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice