Provider Demographics
NPI:1033231014
Name:SMITH, ROY LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:LEE
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 1:107 E LOVE JOY LOOP
Mailing Address - Street 2:
Mailing Address - City:PRICHARD
Mailing Address - State:AL
Mailing Address - Zip Code:36610-3923
Mailing Address - Country:US
Mailing Address - Phone:251-452-3991
Mailing Address - Fax:251-452-6801
Practice Address - Street 1:107 E LOVE JOY LOOP
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:AL
Practice Address - Zip Code:36610-3923
Practice Address - Country:US
Practice Address - Phone:251-452-3991
Practice Address - Fax:251-452-6801
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice