Kimberly Blair Smith DMD PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

3186-01 Issued in MS

Legal business name

KIMBERLY BLAIR SMITH DMD PA

Practice address

409 Main St N
Mendenhall, MS 39114-3318

Phone

(601) 847-1223

Fax

(601) 847-9131

NPI assigned

Jan 5, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Blair Smith, DMDNPI 1649327164

Title

President

Phone

(601) 847-1223

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberly Blair Smith, DMD

  • General Practice Dentistry
  • Mendenhall, MS
  • NPI 1649327164
  NPD (past) Authorized official

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891842332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 MAIN ST N",
            "city": "MENDENHALL",
            "state": "MS",
            "postal_code": "391143318",
            "telephone_number": "601-847-1223",
            "fax_number": "601-847-9131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 MAIN ST N",
            "city": "MENDENHALL",
            "state": "MS",
            "postal_code": "391143318",
            "telephone_number": "601-847-1223",
            "fax_number": "601-847-9131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY BLAIR SMITH DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "BLAIR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-847-1223",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MS",
            "license": "3186-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015751",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Holloway
• Kiara S Hubbard
• Bobbie Hughes
• Amy Jenkins
• Penelope Jones
• Nakecia Dungan Kinabrew, FNP-BC
• Shelley S Leach, FNP
• Peyton Lovelace
• Leanna Maddox
• Shenika Magee, PMHNP

• Dental Clinic/Center in Mendenhall, MS
• Providers in Mendenhall, MS by specialty
• Dental Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.