Provider Demographics
NPI:1093769838
Name:SMITH, TED W IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:W
Last Name:SMITH
Suffix:IV
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 WEBB AVE
Mailing Address - Street 2:#300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3434
Mailing Address - Country:US
Mailing Address - Phone:214-528-7870
Mailing Address - Fax:214-526-1761
Practice Address - Street 1:3110 WEBB AVE
Practice Address - Street 2:#300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3434
Practice Address - Country:US
Practice Address - Phone:214-528-7870
Practice Address - Fax:214-526-1761
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice