Provider Demographics
NPI:1669510475
Name:SMITH, ROB J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROB
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1688
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-1688
Mailing Address - Country:US
Mailing Address - Phone:512-858-9250
Mailing Address - Fax:512-858-2608
Practice Address - Street 1:27490 RANCH ROAD 12 STE 108
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4993
Practice Address - Country:US
Practice Address - Phone:512-858-9250
Practice Address - Fax:512-858-2608
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice