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General NPI Number Information
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NPI Number | 1295099489
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Entity Type | Organization
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Legal Business Name | J. COLBY SMITH, DDS, PA
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 3007 WILLIAMS DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-2778
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Country | US
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Telephone | 512-869-2563
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Fax | 512-863-9372
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Provider Business Mailing Address
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Address Line | 3007 WILLIAMS DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-2778
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Country | US
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Telephone | 512-869-2563
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Fax | 512-863-9372
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Authorized Official
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Title or Position | OWNER
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Name | JOHN COLBY SMITH
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Credential | DDS
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Telephone | 512-869-2563
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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 | 14994
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License Number State | TX
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