Provider Demographics
NPI:1407058662
Name:J.SCOTT SMITH D.D.S.,P.A.
Entity Type:Organization
Organization Name:J.SCOTT SMITH D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-268-5815
Mailing Address - Street 1:2915 EAST MOORE ST.,STE.2
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-2915
Mailing Address - Country:US
Mailing Address - Phone:501-268-5815
Mailing Address - Fax:501-268-5816
Practice Address - Street 1:2915 E MOORE AVE
Practice Address - Street 2:STE.2
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4821
Practice Address - Country:US
Practice Address - Phone:501-268-5815
Practice Address - Fax:501-268-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty