Healthcare Provider Details

I. General information

NPI: 1114114113
Provider Name (Legal Business Name): DANIEL DAVID SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BENNETT RD
OLIVER SPRINGS TN
37840-5005
US

IV. Provider business mailing address

PO BOX 620 102 BENNETT ROAD
OLIVER SPRINGS TN
37840-0620
US

V. Phone/Fax

Practice location:
  • Phone: 865-435-4100
  • Fax:
Mailing address:
  • Phone: 865-435-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS0000008743
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: