Healthcare Provider Details

I. General information

NPI: 1780733055
Provider Name (Legal Business Name): ERIC J. SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 EAST HILTON STREET
KERSHAW SC
29067
US

IV. Provider business mailing address

PO BOX 7
KERSHAW SC
29067
US

V. Phone/Fax

Practice location:
  • Phone: 803-475-6052
  • Fax: 803-475-4407
Mailing address:
  • Phone: 803-475-6052
  • Fax: 803-475-4407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401007612
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberSC8365
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: