Provider Demographics
NPI:1073130134
Name:SMITH, ALONZO RAY (DDS)
Entity Type:Individual
Prefix:
First Name:ALONZO
Middle Name:RAY
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 1:3380 CURTIS DR APT 103
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2606
Mailing Address - Country:US
Mailing Address - Phone:510-827-8797
Mailing Address - Fax:
Practice Address - Street 1:700 MELVIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1506
Practice Address - Country:US
Practice Address - Phone:410-280-5013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD17066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program