Provider Demographics
NPI:1992926091
Name:SMITH, DEENA HOLLIMAN (DMD)
Entity type:Individual
Prefix:DR
First Name:DEENA
Middle Name:HOLLIMAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-1662
Mailing Address - Country:US
Mailing Address - Phone:478-994-1171
Mailing Address - Fax:478-994-2975
Practice Address - Street 1:205 MEDICAL CT
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-1662
Practice Address - Country:US
Practice Address - Phone:478-994-1171
Practice Address - Fax:478-994-2975
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0105491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice