Provider Demographics
NPI:1144609017
Name:SMITH, ROBERT ANDREW III (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREW
Last Name:SMITH
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATTANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16258-1903
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATTANVILLE
Practice Address - State:PA
Practice Address - Zip Code:16258-1903
Practice Address - Country:US
Practice Address - Phone:814-980-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041054122300000X
NC10311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist