Provider Demographics
NPI:1992910947
Name:JEFFREY P. SMITH D.D.S. P.C.
Entity type:Organization
Organization Name:JEFFREY P. SMITH D.D.S. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-723-5423
Mailing Address - Street 1:3101 DROSTE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1109
Mailing Address - Country:US
Mailing Address - Phone:636-723-5423
Mailing Address - Fax:636-946-3372
Practice Address - Street 1:3101 DROSTE RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1109
Practice Address - Country:US
Practice Address - Phone:636-723-5423
Practice Address - Fax:636-946-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO139301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty