Provider Demographics
NPI:1699414003
Name:SMITH, CALEB ROLAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:ROLAND
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 1:107 NE F ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-2603
Mailing Address - Country:US
Mailing Address - Phone:580-298-5581
Mailing Address - Fax:580-298-3310
Practice Address - Street 1:107 NE F ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2603
Practice Address - Country:US
Practice Address - Phone:580-298-5581
Practice Address - Fax:580-298-3310
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist