Provider Demographics
NPI:1487821724
Name:SMITH, NELSON ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:ARTHUR
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:PO BOX 54445
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73154-1445
Mailing Address - Country:US
Mailing Address - Phone:405-990-6065
Mailing Address - Fax:405-842-5706
Practice Address - Street 1:6430 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-2033
Practice Address - Country:US
Practice Address - Phone:405-767-6500
Practice Address - Fax:405-842-5706
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3487122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist