Provider Demographics
NPI:1174735161
Name:SMITH, DAVID JEROME (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEROME
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31450 W. SEVEN MILE ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152
Mailing Address - Country:US
Mailing Address - Phone:248-474-5700
Mailing Address - Fax:247-474-5713
Practice Address - Street 1:31450 7 MILE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1374
Practice Address - Country:US
Practice Address - Phone:248-474-5700
Practice Address - Fax:248-474-5713
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist