Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 4348 | SC |
NPI | 1043419088 |
---|---|
Provider Name | Keenan Webster Smith |
First Address | Greer, SC 29650 |
Second Address | Greer, SC 29650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 11/07/2007 |