Provider Demographics
NPI:1801830948
Name:SMART, STEPHEN CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CRAIG
Last Name:SMART
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4569
Mailing Address - Country:US
Mailing Address - Phone:870-863-0088
Mailing Address - Fax:870-862-4230
Practice Address - Street 1:318 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4569
Practice Address - Country:US
Practice Address - Phone:870-863-0088
Practice Address - Fax:870-862-4230
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
19552OtherQUALCHOICE
AR58158OtherBLUE CROSS BLUE SHIELD
626401OtherUNITED CONCORDIA
T69371Medicare UPIN
58158Medicare ID - Type Unspecified