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Organization
KEENAN W. SMITH, D.M.D., P.A.
Active
Organization
KEENAN W. SMITH, D.M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEENAN WEBSTER SMITH D.M.D. (PRESIDENT)
(864) 676-0825
Entity
Organization
Contact information
Practice address
40 CREEKVIEW CT, GREENVILLE, SC 29615-4800
(864) 676-0825
(864) 676-9859
Mailing address
40 CREEKVIEW CT, GREENVILLE, SC 29615-4800
(864) 676-0825
(864) 676-9859
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4348
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX4348
—
SC
Enumeration date
04/30/2009
Last updated
04/30/2009
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