Provider Demographics
NPI:1780829200
Name:ROBERT P. SMITH, D.D.S
Entity Type:Organization
Organization Name:ROBERT P. SMITH, D.D.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:POWELL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-754-3230
Mailing Address - Street 1:105 1/2 NORTH CRAVENS
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830
Mailing Address - Country:US
Mailing Address - Phone:479-754-3230
Mailing Address - Fax:479-754-3230
Practice Address - Street 1:105 N CRAVENS ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3025
Practice Address - Country:US
Practice Address - Phone:479-754-3230
Practice Address - Fax:479-754-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1721261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103088608Medicaid