Provider Demographics
NPI:1093811929
Name:SMITH-WILES, MERIDETH (DDS)
Entity Type:Individual
Prefix:
First Name:MERIDETH
Middle Name:
Last Name:SMITH-WILES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MERIDETH
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2029 VALLEYGATE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3688
Mailing Address - Country:US
Mailing Address - Phone:910-485-8884
Mailing Address - Fax:910-485-8287
Practice Address - Street 1:2029 VALLEYGATE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3688
Practice Address - Country:US
Practice Address - Phone:910-485-8884
Practice Address - Fax:910-485-8287
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903056Medicaid
NC5903056Medicaid