Healthcare Provider Details

I. General information

NPI: 1841660131
Provider Name (Legal Business Name): ROBERT SMITH DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1347 ROCK SPRINGS RD
SMYRNA TN
37167-6108
US

IV. Provider business mailing address

1347 ROCK SPRINGS RD
SMYRNA TN
37167-6108
US

V. Phone/Fax

Practice location:
  • Phone: 615-355-5822
  • Fax: 615-355-5899
Mailing address:
  • Phone: 615-355-5822
  • Fax: 615-355-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS0000009830
License Number StateTN

VIII. Authorized Official

Name: ROBERT LYNN SMITH
Title or Position: OWNER
Credential: DMD
Phone: 615-355-5822