Provider Demographics
NPI:1104037142
Name:SMITH, ROBBIE T
Entity Type:Individual
Prefix:DR
First Name:ROBBIE
Middle Name:T
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 THOMPSON GLENN PL
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4290
Mailing Address - Country:US
Mailing Address - Phone:919-556-2997
Mailing Address - Fax:919-556-9092
Practice Address - Street 1:12244 WAKE UNION CHURCH RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9549
Practice Address - Country:US
Practice Address - Phone:919-556-2997
Practice Address - Fax:919-556-9092
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice