Provider Demographics
NPI:1528398948
Name:SMITH, ERIC E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:E
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 1:203 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HUMPHREY
Mailing Address - State:NE
Mailing Address - Zip Code:68642-3150
Mailing Address - Country:US
Mailing Address - Phone:402-923-1606
Mailing Address - Fax:402-923-0161
Practice Address - Street 1:203 ELM ST
Practice Address - Street 2:
Practice Address - City:HUMPHREY
Practice Address - State:NE
Practice Address - Zip Code:68642-3150
Practice Address - Country:US
Practice Address - Phone:402-923-1606
Practice Address - Fax:402-923-0161
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist