Provider Demographics
NPI:1376774133
Name:SMITH, ADAM LESLIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:LESLIE
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 1:24165 IH 10 W STE 217-622
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1449
Mailing Address - Country:US
Mailing Address - Phone:530-415-5483
Mailing Address - Fax:
Practice Address - Street 1:6035 NW LOOP 410 STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3301
Practice Address - Country:US
Practice Address - Phone:210-546-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX274681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice