Provider Demographics
NPI:1235229055
Name:SMITH, RICHARD LEE (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LEE
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 1:1204 NW 69 TERRACE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3139
Mailing Address - Country:US
Mailing Address - Phone:352-331-6349
Mailing Address - Fax:352-331-3637
Practice Address - Street 1:1204 NW 69 TERRACE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3139
Practice Address - Country:US
Practice Address - Phone:352-331-6349
Practice Address - Fax:352-331-3637
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN3428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T95463Medicare UPIN