Provider Demographics
NPI:1447875125
Name:SMITH, KATIE ROSE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ROSE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:NICOLE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:761 N DEAN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4027
Mailing Address - Country:US
Mailing Address - Phone:334-821-5291
Mailing Address - Fax:
Practice Address - Street 1:761 N DEAN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4027
Practice Address - Country:US
Practice Address - Phone:334-821-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70841223G0001X
ALD-0006833-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice