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General NPI Number Information
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NPI Number | 1821260498
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Entity Type | Organization
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Legal Business Name | THOMAS D SMITH DMD
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 03/24/2008
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Provider Practice Location Address
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Address Line | 10502 PARK RD SUITE 170
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City | CHARLOTTE
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State | NC
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Zip | 28210-8479
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Country | US
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Telephone | 704-541-5437
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Fax | 704-541-6551
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Provider Business Mailing Address
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Address Line | 10502 PARK ROAD SUITE 170
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City | CHARLOTTE
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State | NC
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Zip | 28210-8479
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Country | US
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Telephone | 704-541-5437
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Fax | 704-541-6551
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS DOUGLAS SMITH
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Credential | DMD
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Telephone | 704-541-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 3967
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License Number State | NC
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