Provider Demographics
NPI:1720133960
Name:DENNIS R. SMITH DDS, INC.
Entity type:Organization
Organization Name:DENNIS R. SMITH DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:478-628-2142
Mailing Address - Street 1:106 COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:31031-0326
Mailing Address - Country:US
Mailing Address - Phone:478-628-2142
Mailing Address - Fax:478-628-1400
Practice Address - Street 1:106 COLLEGE STREET
Practice Address - Street 2:106 COLLEGE STREET
Practice Address - City:GORDON
Practice Address - State:GA
Practice Address - Zip Code:31031-0326
Practice Address - Country:US
Practice Address - Phone:478-628-2142
Practice Address - Fax:478-628-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100138OtherAVESIS PEACHSTATE #
GA108516OtherDORAL WELLCARE LOCATOR ID
GA108516OtherDORAL WELLCARE LOCATOR ID