Provider Demographics
NPI:1518162635
Name:SMITH, J. ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:ANTHONY
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 1:306 NE BLAKE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5328
Mailing Address - Country:US
Mailing Address - Phone:479-273-9444
Mailing Address - Fax:
Practice Address - Street 1:306 NE BLAKE ST STE 3
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5328
Practice Address - Country:US
Practice Address - Phone:479-273-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR36171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice