Provider Demographics
NPI:1689608259
Name:SMITH, HENRY ZACK (DDS, MS, PA)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ZACK
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 ELLERSLIE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5917
Mailing Address - Country:US
Mailing Address - Phone:910-867-2707
Mailing Address - Fax:
Practice Address - Street 1:573 EXECUTIVE PLACE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305
Practice Address - Country:US
Practice Address - Phone:910-323-5821
Practice Address - Fax:910-323-4357
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics