Provider Demographics
NPI:1790774875
Name:SMITH, BEN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1189
Mailing Address - Country:US
Mailing Address - Phone:575-746-9848
Mailing Address - Fax:575-746-9840
Practice Address - Street 1:1105 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1189
Practice Address - Country:US
Practice Address - Phone:575-746-9848
Practice Address - Fax:575-746-9840
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM15751223S0112X
NMDD15751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery