| Organization Name: | KIMBERLY BLAIR SMITH DMD PA |
| NPI Number: | 1891842332 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY BLAIR SMITH (PRESIDENT) |
| Mailing Address: | 409 Main St N Mendenhall |
| State: | MS US |
| Postal Code: | 391143318 |
| Phone Number: | 6018471223 |
| Fax Number: | 6018479131 |
| NPI Enumeration Date: | 01/05/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 3186-01 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |