Dennis Rayvon Smith, DDS
Individual provider Active NPI Dentist · Gordon, GA
NPI 1124173356 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124173356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 10175 (GA)
- Practice address
- 106 College Street
Gordon, GA 31031-0326 - Phone
- (478) 628-2142
- Fax
- (478) 628-1400
- NPI assigned
- Jan 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dennis R. Smith DDS, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10175 | GA | Yes |
Addresses
Primary practice location
106 College Street
Gordon, GA 31031-0326
Mailing address
PO Box 326
106 College Street
Gordon, GA 31031-0326
Phone (478) 628-2142
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100138 | Other | GA | AVESIS |
| 000018378C | Medicaid | GA | |
| 108516 | Other | GA | DORAL - WELLCARE |
| 582423363 | Other | GA | TAX ID # |
Other providers in Gordon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.