Provider Demographics
NPI:1194816520
Name:SMITH, MARC RYAN (DDS)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:RYAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:15901 CENTRAL COMMERCE DR
Mailing Address - Street 2:SUITE 601
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2041
Mailing Address - Country:US
Mailing Address - Phone:512-989-7855
Mailing Address - Fax:512-989-7859
Practice Address - Street 1:15901 CENTRAL COMMERCE DR
Practice Address - Street 2:SUITE 601
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2041
Practice Address - Country:US
Practice Address - Phone:512-989-7855
Practice Address - Fax:512-989-7859
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TX198121223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology