Provider Demographics
NPI:1245562214
Name:SMITH ESTATE, EARL A (DDS)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:A
Last Name:SMITH ESTATE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:2400 HIGHWAY 95
Mailing Address - Street 2:SUITE 60
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7313
Mailing Address - Country:US
Mailing Address - Phone:928-758-5955
Mailing Address - Fax:928-758-5993
Practice Address - Street 1:2400 HIGHWAY 95
Practice Address - Street 2:SUITE 60
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7313
Practice Address - Country:US
Practice Address - Phone:928-758-5955
Practice Address - Fax:928-758-5993
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4687124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist