Healthcare Provider Details

I. General information

NPI: 1023512746
Provider Name (Legal Business Name): HILARY SMITH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 HIGHWAY 29 N
ATHENS GA
30601-1513
US

IV. Provider business mailing address

1950 HOWELL MILL RD NW APT 3029
ATLANTA GA
30318-2663
US

V. Phone/Fax

Practice location:
  • Phone: 706-389-1301
  • Fax:
Mailing address:
  • Phone: 678-325-9558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN015882
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: