Provider Demographics
NPI:1780844977
Name:TOM M SMITH, DDS, INC
Entity Type:Organization
Organization Name:TOM M SMITH, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:903-758-3329
Mailing Address - Street 1:444 FOREST SQ
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4463
Mailing Address - Country:US
Mailing Address - Phone:903-758-3329
Mailing Address - Fax:903-758-4784
Practice Address - Street 1:444 FOREST SQ
Practice Address - Street 2:SUITE A
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4463
Practice Address - Country:US
Practice Address - Phone:903-758-3329
Practice Address - Fax:903-758-4784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1891883757OtherINDIVIDUAL NPI