Samuel M Smith DMD PHD PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SAMUEL M SMITH DMD PHD PC

Practice address

1519 East McCord St
Centralia, IL 62801

Phone

(618) 532-1879

Fax

(618) 532-0479

NPI assigned

Feb 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel Madison Smith Jr., DMD PHD PC

Title

Owner

Phone

(618) 532-1879

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202947200000",
    "number": "1174791990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1519 EAST MCCORD ST",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "62801",
            "telephone_number": "618-532-1879",
            "fax_number": "618-532-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 EAST MCCORD ST",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "62801",
            "telephone_number": "618-532-1879",
            "fax_number": "618-532-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMUEL M SMITH DMD PHD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2008-02-14",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "MADISON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-532-1879",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD PHD PC"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Rugowski, LCPC
• Lisa Marie Russow
• Usha Kiran Sadanala, MD
• Sajjan K Nemani MD SC
• Kimberly Salmon, COTA/L
• Laura Sanders
• Venerio Melendres Santos, MD
• Travis Sarasky
• Christine Nichole Schatz, DC
• Jessie M Schaudt

• Dentist in Centralia, IL
• Providers in Centralia, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.