Individual
THOMAS IVERSON SMITH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
23 PROFESSIONAL DR, BRUNSWICK, GA 31520-3773
(912) 265-7273
(912) 261-2792
Mailing address
23 PROFESSIONAL DR, BRUNSWICK, GA 31520-3773
(912) 265-7273
(912) 261-2792
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
11022
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
681685
UNITED CONCORDIA PROVIDER
GA
Enumeration date
06/06/2006
Last updated
07/08/2007
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