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General NPI Number Information
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NPI Number | 1003147000
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Entity Type | Organization
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Legal Business Name | SMITH ORTHODONTICS
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 1941 S. HWY. 119
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City | MEBANE
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State | NC
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Zip | 23702
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Country | US
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Telephone | 919-563-4746
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Fax |
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Provider Business Mailing Address
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Address Line | 1941 HIGHWAY 119 SOUTH
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City | MEBANE
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State | NC
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Zip | 27302
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Country | US
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Telephone | 919-563-4746
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | JACK DEMPSEY SMITH
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Credential | DMD, MS
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Telephone | 919-563-4746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 7329
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License Number State | NC
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