Provider Demographics
NPI:1619184322
Name:SMITH, GILBERT ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:ERIC
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 1:1478 LAKE SHORE RD
Mailing Address - Street 2:
Mailing Address - City:CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12921-3402
Mailing Address - Country:US
Mailing Address - Phone:518-846-3163
Mailing Address - Fax:
Practice Address - Street 1:326 TOM MILLER RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6430
Practice Address - Country:US
Practice Address - Phone:518-563-7097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0440611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice