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NPI Code Detail

MEDICARE: JACKIE L. SMITH, DDS, PLLC

MEDICARE: JACKIE L. SMITH, DDS, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist1991AR

General Provider Information

NPI Number : 1487031969
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACKIE L. SMITH, DDS, PLLC
Provider Business Mailing Address
First Line : 6315 RANCH DR.
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72223-0000
Country : US
Telephone Number : 501-821-2214
Fax Number :
Provider Business Practice Location Address
First Line : 6315 RANCH DR.
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72223-0000
Country : US
Telephone Number : 501-821-2214
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : DR. JACKIE L SMITH
Credential :
Telephone Number : 501-993-4029
Provider Enumeration Date : 05/04/2015
Last Update Date : 05/11/2015

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Directions to “JACKIE L. SMITH, DDS, PLLC ” Practice Location

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