Provider Demographics
NPI:1780733055
Name:SMITH, ERIC J (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:KERSHAW
Mailing Address - State:SC
Mailing Address - Zip Code:29067
Mailing Address - Country:US
Mailing Address - Phone:803-475-6052
Mailing Address - Fax:803-475-4407
Practice Address - Street 1:114 EAST HILTON STREET
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067
Practice Address - Country:US
Practice Address - Phone:803-475-6052
Practice Address - Fax:803-475-4407
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010076121223G0001X
SCSC83651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice