Individual
DR. DENNIS RAYVON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
106 COLLEGE STREET, GORDON, GA 31031-0326
(478) 628-2142
(478) 628-1400
Mailing address
PO BOX 326, 106 COLLEGE STREET, GORDON, GA 31031-0326
(478) 628-2142
(478) 628-1400
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10175
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000018378C
—
GA
01
—
100138
AVESIS
GA
01
—
108516
DORAL - WELLCARE
GA
01
—
582423363
TAX ID #
GA
Enumeration date
01/25/2007
Last updated
07/08/2007
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