Provider Demographics
NPI:1407920887
Name:SMITH, RICHARD STAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STAN
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 1:3525 YALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-5633
Mailing Address - Country:US
Mailing Address - Phone:325-676-9137
Mailing Address - Fax:
Practice Address - Street 1:3525 YALE AVENUE
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-5633
Practice Address - Country:US
Practice Address - Phone:325-676-9137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice