Provider Demographics
NPI:1487736823
Name:SMITH, MICHAEL GROVER (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GROVER
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1190 GRIMES BRIDGE RD
Mailing Address - Street 2:STE B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075
Mailing Address - Country:US
Mailing Address - Phone:770-998-8116
Mailing Address - Fax:770-998-8134
Practice Address - Street 1:1190 GRIMES BRIDGE RD
Practice Address - Street 2:STE B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075
Practice Address - Country:US
Practice Address - Phone:770-998-8116
Practice Address - Fax:770-998-8134
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0099761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice