Spencer Kennedy Smith, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2019020377 Issued in MO

Practice address

301 Fisher St
Keesler Afb, MS 39534-2508

Phone

(228) 376-3060

NPI assigned

Mar 29, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1255892394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 FISHER ST",
            "city": "KEESLER AFB",
            "state": "MS",
            "postal_code": "395342508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 FISHER ST",
            "city": "KEESLER AFB",
            "state": "MS",
            "postal_code": "395342508",
            "telephone_number": "228-376-3060"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18th Medical Group",
            "address_2": "Unit 5142",
            "address_purpose": "LOCATION",
            "city": "APO",
            "state": "AP",
            "postal_code": "963685142",
            "country_code": "US",
            "telephone_number": "315-630-4902",
            "country_name": "United States",
            "address_type": "MIL"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SPENCER",
        "middle_name": "KENNEDY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-29",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2019020377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miriam Seville, RD, CSSD
• Gregg Stephen Silberg, D.O.
• Benjamin Probie Smith, M.D.
• Justin Scott Smith, DNP, CRNA
• Marcia R Smith, CRNA
• Thomas Patrick Smith, MD
• Nicholas Stinson, DO
• James Lewis Strawn IV, IDMT
• Kody Lee Stroschein, DO
• Michael Struthers

• General Practice Dentistry in Keesler Afb, MS
• Providers in Keesler Afb, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; 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.