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General NPI Number Information
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NPI Number | 1184304081
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Entity Type | Individual
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Provider Name | KADIJAH S SMITH DDS
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Gender | Female
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 3120 STONECREST BLVD STE 100
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City | STONECREST
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State | GA
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Zip | 30038-2693
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Country | US
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Telephone | 770-484-4994
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Fax |
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Provider Business Mailing Address
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Address Line | 125 N ARCADIA AVE APT 224
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City | DECATUR
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State | GA
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Zip | 30030-2153
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Country | US
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Telephone | 901-574-8930
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN123197
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License Number State | GA
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