Provider Demographics
NPI:1710096540
Name:TODD SMITH DDS PA
Entity Type:Organization
Organization Name:TODD SMITH DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LABOUNTY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-629-1954
Mailing Address - Street 1:1583 COMMON STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-629-1954
Mailing Address - Fax:830-625-3114
Practice Address - Street 1:1583 COMMON STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-629-1954
Practice Address - Fax:830-625-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD16539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1399228OtherUNITED CONCORDIA
TX25JMOtherBLUE CROSS BLUE SHIELD