Organization
SAMUEL M SMITH DMD PHD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL MADISON SMITH JR. DMD PHD PC (OWNER)
(618) 532-1879
Entity
Organization
Contact information
Practice address
1519 EAST MCCORD ST, CENTRALIA, IL 62801
(618) 532-1879
(618) 532-0479
Mailing address
1519 EAST MCCORD ST, CENTRALIA, IL 62801
(618) 532-1879
(618) 532-0479
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
02/14/2008
Last updated
02/14/2008
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