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General NPI Number Information
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NPI Number | 1629523626
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Entity Type | Organization
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Legal Business Name | VERNON SMITH DMD PLLC
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 4145 US HIGHWAY 98 N
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City | LAKELAND
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State | FL
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Zip | 33809-3830
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Country | US
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Telephone | 863-858-3891
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Fax | 863-859-5301
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Provider Business Mailing Address
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Address Line | 4145 US HIGHWAY 98 N
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City | LAKELAND
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State | FL
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Zip | 33809-3830
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Country | US
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Telephone | 863-858-3891
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Fax | 863-859-5301
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Authorized Official
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Title or Position | DENTIST
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Name | VERNON STEPHEN SMITH
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Credential | DMD
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Telephone | 863-858-3891
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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 | DN19861
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License Number State | FL
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