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General NPI Number Information
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NPI Number | 1699405878
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Entity Type | Individual
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Provider Name | CARSON SMITH DMD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2022
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Last Update Date | 06/12/2022
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Provider Practice Location Address
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Address Line | 540 FIELDCREST DR
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City | LADY LAKE
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State | FL
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Zip | 32162-4601
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Country | US
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Telephone | 352-205-7667
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Fax | 352-205-8754
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Provider Business Mailing Address
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Address Line | 13773 NE 136TH LOOP UNIT 6109
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City | LADY LAKE
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State | FL
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Zip | 32159-6936
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Country | US
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Telephone | 321-262-2665
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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 | 26933
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License Number State | FL
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