Provider Demographics
NPI:1073785622
Name:JOSEPH R SMITH,II, DDS,PA
Entity Type:Organization
Organization Name:JOSEPH R SMITH,II, DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-825-1131
Mailing Address - Street 1:3877 JAMES STREET
Mailing Address - Street 2:PO BOX 936
Mailing Address - City:BETHEL
Mailing Address - State:NC
Mailing Address - Zip Code:27812-0936
Mailing Address - Country:US
Mailing Address - Phone:252-825-1131
Mailing Address - Fax:252-825-0220
Practice Address - Street 1:3877 JAMES STREET
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:NC
Practice Address - Zip Code:27812-0936
Practice Address - Country:US
Practice Address - Phone:252-825-1131
Practice Address - Fax:252-825-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4119302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997937Medicaid