Provider Demographics
NPI:1316033004
Name:SMITH, WALTER HAYWOOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:HAYWOOD
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 1:2505 LARKIN ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:859-278-6009
Mailing Address - Fax:859-278-4443
Practice Address - Street 1:2505 LARKIN ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-278-6009
Practice Address - Fax:859-278-4443
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4084122300000X
KY1951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4084OtherSTATE LICENSE NUMBER
KYSTATE LICENSE NUMBEROther195 PEDIATRIC DENTISTRY