Provider Demographics
NPI:1790793867
Name:SMITH, STEVEN WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 N LAKELINE BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-6798
Mailing Address - Country:US
Mailing Address - Phone:512-219-1389
Mailing Address - Fax:512-219-0725
Practice Address - Street 1:100 N LAKELINE BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6798
Practice Address - Country:US
Practice Address - Phone:512-219-1389
Practice Address - Fax:512-219-0725
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26-4639347OtherCEDAR PARK SMILES PLLC EIN NUMBER
TX74-2885624OtherTIN