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General NPI Number Information
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NPI Number | 1326066481
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Entity Type | Individual
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Provider Name | DUSTIN G. SMITH DMD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1718 S MAIN ST
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City | POPLARVILLE
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State | MS
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Zip | 39470-4287
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Country | US
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Telephone | 601-795-8024
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Fax | 601-795-0745
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Provider Business Mailing Address
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Address Line | PO BOX 73 1718 SOUTH MAIN STREET
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City | POPLARVILLE
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State | MS
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Zip | 39470-0073
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Country | US
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Telephone | 601-795-8024
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Fax | 601-795-0745
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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 | 3142-00
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License Number State | MS
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