Provider Demographics
NPI:1417976333
Name:SMITH, PAUL FREDLAND JR (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:FREDLAND
Last Name:SMITH
Suffix:JR
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 1:3461 WARRENSVILLE CENTER RD
Mailing Address - Street 2:STE 306
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5227
Mailing Address - Country:US
Mailing Address - Phone:216-751-3800
Mailing Address - Fax:216-751-3801
Practice Address - Street 1:20119 FARNSLEIGH RD.
Practice Address - Street 2:#207
Practice Address - City:SHAKER HTS.
Practice Address - State:OH
Practice Address - Zip Code:44122-3613
Practice Address - Country:US
Practice Address - Phone:216-751-3800
Practice Address - Fax:216-751-3801
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300158681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery