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General NPI Number Information
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NPI Number | 1598157315
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Entity Type | Organization
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Legal Business Name | SMITH DENTAL CARE
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 259 ATHENS ST
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City | HARTWELL
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State | GA
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Zip | 30643-1854
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Country | US
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Telephone | 706-376-2345
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Fax | 706-376-7244
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Provider Business Mailing Address
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Address Line | 259 ATHENS ST
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City | HARTWELL
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State | GA
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Zip | 30643-1854
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Country | US
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Telephone | 706-376-2345
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Fax | 706-376-7244
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. CHARLES MELVIN SMITH JR.
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Credential | DMD
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Telephone | 706-376-2345
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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 | 11202
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License Number State | GA
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