Provider Demographics
NPI:1548573702
Name:SMITH, ERIK J (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1328
Mailing Address - Country:US
Mailing Address - Phone:774-284-4589
Mailing Address - Fax:
Practice Address - Street 1:2578 IDAHO ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4601
Practice Address - Country:US
Practice Address - Phone:775-299-4790
Practice Address - Fax:757-738-0495
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL10984122300000X
PADS0391041223P0221X
IDD-4560-PD1223P0221X
NVS6-127C1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist