Provider Demographics
NPI:1376596189
Name:SMITH, LEONARD WILTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:WILTON
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1901 MEDI PARK
Mailing Address - Street 2:STE 215
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2110
Mailing Address - Country:US
Mailing Address - Phone:806-353-2111
Mailing Address - Fax:806-354-8277
Practice Address - Street 1:1901 MEDI PARK
Practice Address - Street 2:SUITE 215
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-353-2111
Practice Address - Fax:806-354-8277
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95491223P0106X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Not Answered1223P0300XDental ProvidersDentistPeriodontics