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DR. JESSANNA ELIZABETH SMITH DMD
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1972764926
Individual Registrant:DR. JESSANNA ELIZABETH SMITH DMD
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
602 1ST AVE UNIT B TYBEE ISLAND, GA 31328-8841 US
Tel: 912-786-9433 Fax: --
Tel: 912-786-9433 Fax: --
Contact information for business:
602 FIRST STREET UNIT B TYBEE ISLAND, GA 31328 US
Tel: 912-786-9433 Fax: --
Tel: 912-786-9433 Fax: --
Registration Information:
NPI: 1972764926
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 1223G0001X | Dental Providers Dentist General Practice | SC | 4493 |
| Y | 1223G0001X | Dental Providers Dentist | GA | DN013791 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
