Provider Demographics
NPI:1962678425
Name:SMITH, GERALD A
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:A
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3755 SIXES RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7842
Mailing Address - Country:US
Mailing Address - Phone:770-704-7157
Mailing Address - Fax:
Practice Address - Street 1:3755 SIXES RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7842
Practice Address - Country:US
Practice Address - Phone:770-704-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0102441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics