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General NPI Number Information
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NPI Number | 1699407361
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Entity Type | Individual
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Provider Name | DUSTIN KYLE SMITH JR. DMD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 256 39TH ST BLDG 38717
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City | FORT EISENHOWER
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State | GA
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Zip | 30905-6102
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Country | US
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Telephone | 843-455-8728
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Fax |
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Provider Business Mailing Address
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Address Line | 256 39TH ST BLDG 38717
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City | FORT EISENHOWER
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State | GA
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Zip | 30905-6102
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Country | US
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Telephone | 843-455-8728
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 10191
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License Number State | SC
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