Provider Demographics
NPI:1497876015
Name:SMITH, GRAYSON BENNETT JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRAYSON
Middle Name:BENNETT
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:G
Other - Middle Name:BENNETT
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:933 OLD ROCKFORD STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5356
Mailing Address - Country:US
Mailing Address - Phone:336-789-5306
Mailing Address - Fax:336-789-3311
Practice Address - Street 1:933 OLD ROCKFORD STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5356
Practice Address - Country:US
Practice Address - Phone:336-789-5306
Practice Address - Fax:336-789-3311
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997864Medicaid