Individual
KIMBERLY BLAIR SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
409 MAIN ST N, MENDENHALL, MS 39114-3318
(601) 847-1223
(601) 847-9131
Mailing address
238 JAMES BERRY RD, MAGEE, MS 39111-5248
(601) 849-9569
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3186-01
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0660390
—
MS
Enumeration date
01/05/2007
Last updated
07/08/2007
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