Provider Demographics
NPI:1245407147
Name:SMITH, ERIC SHAWN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SHAWN
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 1:3901 FM 2181
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210
Mailing Address - Country:US
Mailing Address - Phone:940-321-2340
Mailing Address - Fax:940-321-2394
Practice Address - Street 1:3901 FM 2181
Practice Address - Street 2:SUITE 100
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210
Practice Address - Country:US
Practice Address - Phone:940-321-2340
Practice Address - Fax:940-321-2394
Is Sole Proprietor?:No
Enumeration Date:2008-05-11
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice