Provider Demographics
NPI:1659824258
Name:SMITH, GRANT EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:EDWARD
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 1:2400 N LOCKHART ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-2904
Mailing Address - Country:US
Mailing Address - Phone:903-814-6366
Mailing Address - Fax:903-868-0633
Practice Address - Street 1:2011 W LAMBERTH RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2318
Practice Address - Country:US
Practice Address - Phone:903-893-8030
Practice Address - Fax:903-868-0633
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist