Samuel M Smith Dmd PHD PC

NPI #1174791990 in Centralia, Illinois

Provider Information

NPI Number: 1174791990
Entity Type: Organization
Organization Name: Samuel M Smith Dmd PHD PC
Primary Specialty: Dentist
Enumeration Date: Feb 14, 2008
Last Updated: Feb 14, 2008

Practice Location

Address: 1519 EAST MCCORD ST
City: Centralia
State: Illinois
ZIP Code: 62801
Phone: (618) 532-1879

Authorized Official

Name: SAMUEL MADISON SMITH JR., DMD PHD PC
Title: OWNER
Phone: (618) 532-1879

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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