Provider Demographics
NPI:1689717670
Name:SMITH, BENJAMIN LENNIS III (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LENNIS
Last Name:SMITH
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 898
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-0898
Mailing Address - Country:US
Mailing Address - Phone:940-458-7441
Mailing Address - Fax:940-458-7286
Practice Address - Street 1:107 SOUTH STEMMONS
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-0898
Practice Address - Country:US
Practice Address - Phone:940-458-7441
Practice Address - Fax:940-458-7286
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice