Healthcare Provider Details

I. General information

NPI: 1396298253
Provider Name (Legal Business Name): CAITLIN CORACY SMITH D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 01/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 STATE ST
CAYCE SC
29033-4344
US

IV. Provider business mailing address

1313 STATE ST
CAYCE SC
29033-4344
US

V. Phone/Fax

Practice location:
  • Phone: 803-796-1734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDGD 8780
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: