Provider Demographics
NPI:1295817104
Name:SMITH, DUANE MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:MICHAEL
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:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:79096-0468
Mailing Address - Country:US
Mailing Address - Phone:806-826-5505
Mailing Address - Fax:806-826-5051
Practice Address - Street 1:306 E. 9TH ST.
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:TX
Practice Address - Zip Code:79096
Practice Address - Country:US
Practice Address - Phone:806-826-5505
Practice Address - Fax:806-826-5051
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice