1073835328 NPI number — DR. WILLIAM EDGAR SMITH DMD

Table of content: DR. WILLIAM EDGAR SMITH DMD (NPI 1073835328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073835328 NPI number — DR. WILLIAM EDGAR SMITH DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
WILLIAM
Provider Middle Name:
EDGAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
BILL
Provider Other Middle Name:
E.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073835328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BLDG 2441 21ST STREET
Provider Second Line Business Mailing Address:
US ARMY DENTAL ACTIVITY
Provider Business Mailing Address City Name:
FORT CAMPBELL
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-798-8751
Provider Business Mailing Address Fax Number:
270-956-0266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLDG 2441 21ST STREET
Provider Second Line Business Practice Location Address:
US ARMY DENTAL ACTIVITY
Provider Business Practice Location Address City Name:
FORT CAMPBELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-798-8751
Provider Business Practice Location Address Fax Number:
270-956-0266
Provider Enumeration Date:
02/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS7100 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 58-1943033 . This is a "TAX ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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