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Individual

JACKIE L SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
154 WELFORD LN, BRANSON, MO 65616-3418
(417) 332-2980
Mailing address
154 WELFORD LN, BRANSON, MO 65616-3418
(417) 332-2980

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
1935
TN
122300000X
Dentist
1991
AR
122300000X
Dentist
Primary
2007034336
MO

Other

Enumeration date
10/13/2010
Last updated
10/13/2010
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