Healthcare Provider Details

I. General information

NPI: 1497928485
Provider Name (Legal Business Name): TODDRICK SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 KIRBY CENTER CV
MEMPHIS TN
38115-4313
US

IV. Provider business mailing address

6611 KIRBY CENTER CV
MEMPHIS TN
38115-4313
US

V. Phone/Fax

Practice location:
  • Phone: 901-363-8192
  • Fax:
Mailing address:
  • Phone: 901-363-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8676
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8676
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: