Provider Demographics
NPI:1225628167
Name:SMITH, PAUL STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEPHEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TUSKEGEE BLVD
Mailing Address - Street 2:
Mailing Address - City:DOVER AIR FORCE BASE
Mailing Address - State:DE
Mailing Address - Zip Code:19902-5003
Mailing Address - Country:US
Mailing Address - Phone:302-677-2028
Mailing Address - Fax:302-677-3231
Practice Address - Street 1:BLDG 140
Practice Address - Street 2:
Practice Address - City:RAF CROUGHTON
Practice Address - State:TX
Practice Address - Zip Code:09494
Practice Address - Country:US
Practice Address - Phone:314-236-8739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351411223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice