Provider Demographics
NPI:1699349050
Name:SMITH AND PAUL DENTISTRY LLC
Entity type:Organization
Organization Name:SMITH AND PAUL DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERSOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-582-3300
Mailing Address - Street 1:12066 SMITHFIELD FARM LN
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-2166
Mailing Address - Country:US
Mailing Address - Phone:301-582-3300
Mailing Address - Fax:
Practice Address - Street 1:12066 SMITHFIELD FARM LN
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-2166
Practice Address - Country:US
Practice Address - Phone:301-582-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty