Healthcare Provider Details

I. General information

NPI: 1831761402
Provider Name (Legal Business Name): SYDNEY SMITH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 OLD FURNACE RD
BOILING SPRINGS SC
29316-8591
US

IV. Provider business mailing address

1860 OLD FURNACE RD
BOILING SPRINGS SC
29316-8591
US

V. Phone/Fax

Practice location:
  • Phone: 864-592-1647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9992
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: