Provider Demographics
NPI:1790101020
Name:B KENT SMITH DDS PA
Entity Type:Organization
Organization Name:B KENT SMITH DDS PA
Other - Org Name:SLEEP DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:B KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:844-409-4657
Mailing Address - Street 1:3800 GAYLORD PKWY STE 1190
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9418
Mailing Address - Country:US
Mailing Address - Phone:844-409-4657
Mailing Address - Fax:214-614-4277
Practice Address - Street 1:3800 GAYLORD PKWY STE 1190
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9416
Practice Address - Country:US
Practice Address - Phone:844-409-4657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14695122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6543690001OtherMEDICARE PTAN