Provider Demographics
NPI:1013035757
Name:SMITH, STEPHANIE SUZANNE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:SUZANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 RIDGE RD STE 500
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-5107
Mailing Address - Country:US
Mailing Address - Phone:972-529-9700
Mailing Address - Fax:972-542-8001
Practice Address - Street 1:175 RIDGE RD STE 500
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5107
Practice Address - Country:US
Practice Address - Phone:972-529-9700
Practice Address - Fax:972-542-8001
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX184181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics