Provider Demographics
NPI:1235872110
Name:SMITH, AUSTIN JAMES
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 THONOTOSASSA RD STE B
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-2972
Mailing Address - Country:US
Mailing Address - Phone:138-752-3555
Mailing Address - Fax:
Practice Address - Street 1:2005 THONOTOSASSA RD STE B
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2972
Practice Address - Country:US
Practice Address - Phone:138-752-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL275651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry