Provider Demographics
NPI:1366119497
Name:SMITH DENTAL CARE OF SAVANNAH, LLC
Entity type:Organization
Organization Name:SMITH DENTAL CARE OF SAVANNAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DN 011212
Authorized Official - Phone:706-255-0514
Mailing Address - Street 1:3700 ATLANTA HWY STE 10
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7201
Mailing Address - Country:US
Mailing Address - Phone:706-255-0514
Mailing Address - Fax:
Practice Address - Street 1:7400 ABERCORN ST STE 814
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2455
Practice Address - Country:US
Practice Address - Phone:912-542-0432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMITH DENTAL CARE OF ATHENS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty