Provider Demographics
NPI:1437129228
Name:SMITH, MILLARD BEDFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILLARD
Middle Name:BEDFORD
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 1:501 PENNY LANE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557
Mailing Address - Country:US
Mailing Address - Phone:252-247-2258
Mailing Address - Fax:252-247-7783
Practice Address - Street 1:501 PENNY LANE
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557
Practice Address - Country:US
Practice Address - Phone:252-247-2258
Practice Address - Fax:252-247-7783
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
822407OtherUNITED CONCORDIA
NC8997871Medicaid
NC97871OtherBCBSNC
NCU49199Medicare UPIN
NC97871OtherBCBSNC