Provider Demographics
NPI:1972563468
Name:REDFORD, DONALD SMITH (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:SMITH
Last Name:REDFORD
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 1:350 BLOUNTVILLE HWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-0213
Mailing Address - Country:US
Mailing Address - Phone:423-968-4114
Mailing Address - Fax:423-968-4294
Practice Address - Street 1:350 BLOUNTVILLE HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-0213
Practice Address - Country:US
Practice Address - Phone:423-968-4114
Practice Address - Fax:423-968-4294
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0038451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3224945Medicaid
VA8019894Medicaid
VA8019894Medicaid
TNT74383Medicare UPIN