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General NPI Number Information
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NPI Number | 1265749196
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Entity Type | Individual
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Provider Name | JESSICA SMITH DDS
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Gender | Female
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 9732 MIDLOTHIAN TPKE
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City | RICHMOND
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State | VA
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Zip | 23235-4962
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Country | US
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Telephone | 804-320-3683
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Fax |
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Provider Business Mailing Address
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Address Line | 3941 PAULHILL RD
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City | RICHMOND
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State | VA
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Zip | 23236-1232
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401412969
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License Number State | VA
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