Healthcare Provider Details

I. General information

NPI: 1740735638
Provider Name (Legal Business Name): CAMDEN JAKOB SMITH D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 S 5TH ST
MACCLENNY FL
32063-2602
US

IV. Provider business mailing address

1665 EAGLE HARBOR PKWY
FLEMING ISLAND FL
32003-4802
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-5007
  • Fax:
Mailing address:
  • Phone: 904-337-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6329
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 22467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: