Provider Demographics
NPI:1811033004
Name:SMITH, STANLEY MONTGOMERY (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:MONTGOMERY
Last Name:SMITH
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 1:3109 SOUTH 27TH STREET
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6239
Mailing Address - Country:US
Mailing Address - Phone:325-692-7670
Mailing Address - Fax:
Practice Address - Street 1:3109 SOUTH 27TH STREET
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6239
Practice Address - Country:US
Practice Address - Phone:325-692-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9387122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist