Provider Demographics
NPI:1467671065
Name:SMITH, DURRELL PADGITT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DURRELL
Middle Name:PADGITT
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 1:2373 TWIGHLIGHT PENINSULA
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-8769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4818 WELLINGTON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6010
Practice Address - Country:US
Practice Address - Phone:903-455-5750
Practice Address - Fax:903-455-5888
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice