Provider Demographics
NPI:1578693859
Name:SMITH, ROBERT LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
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 1:1700 NE 26TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1430
Mailing Address - Country:US
Mailing Address - Phone:954-564-7121
Mailing Address - Fax:954-564-7122
Practice Address - Street 1:1700 NE 26TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1430
Practice Address - Country:US
Practice Address - Phone:954-564-7121
Practice Address - Fax:954-564-7122
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice