MEDICARE: J. KEITH SMITH, D.M.D., P.C.

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
1	1223G0001X	General Practice Dentistry	DN011118	GA

General Provider Information

NPI Number	:	1780892596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. KEITH SMITH, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	1777 LEE RD
Second Line	:	SUITE D
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3073
Country	:	US
Telephone Number	:	770-948-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1777 LEE RD
Second Line	:	SUITE D
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3073
Country	:	US
Telephone Number	:	770-948-1600
Fax Number	:

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	DR. JAMES KEITH SMITH
Credential	:	D.M.D.
Telephone Number	:	770-948-1600

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	08/22/2020

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