Provider Demographics
NPI:1770844581
Name:SMITH, BECKY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BECKY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15218 W 132ND PL
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1590
Mailing Address - Country:US
Mailing Address - Phone:913-254-1433
Mailing Address - Fax:
Practice Address - Street 1:15218 W 132ND PL
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1590
Practice Address - Country:US
Practice Address - Phone:913-254-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE015783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist