=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073897310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAYLIA C. SMITH, DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2011
-----------------------------------------------------
Last Update Date | 10/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 408 BURLINGTON AVE
-----------------------------------------------------
City | GIBSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27249-2865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-449-6423
-----------------------------------------------------
Fax | 336-449-9200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 198 408 BURLINGTON AVE
-----------------------------------------------------
City | GIBSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27249-0198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-449-6423
-----------------------------------------------------
Fax | 336-449-9200
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. GAYLIA CHAVIS SMITH
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 336-449-6423
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------