Healthcare Provider Details

I. General information

NPI: 1215951132
Provider Name (Legal Business Name): DONALD L. SMITHA DDS, MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 ALDERMAN RD
JACKSONVILLE FL
32211-6102
US

IV. Provider business mailing address

812 ALDERMAN RD
JACKSONVILLE FL
32211-6102
US

V. Phone/Fax

Practice location:
  • Phone: 904-725-8282
  • Fax: 904-725-7197
Mailing address:
  • Phone: 904-725-8282
  • Fax: 904-725-7197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN 5802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: