Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7849 | TN |
NPI | 1124151345 |
---|---|
Provider Name | Dr. Andrea M. Smith |
First Address | Memphis, TN 38104-4392 |
Second Address | Forrest City, AR 72335-2695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 30/04/2014 |