Provider Demographics
NPI:1811198484
Name:DR TIM R. SMITH PA
Entity Type:Organization
Organization Name:DR TIM R. SMITH PA
Other - Org Name:TIM SMITH DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-592-5934
Mailing Address - Street 1:6439 OLD JACKSONVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0577
Mailing Address - Country:US
Mailing Address - Phone:903-592-5934
Mailing Address - Fax:903-597-8822
Practice Address - Street 1:6439 OLD JACKSONVILLE HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0577
Practice Address - Country:US
Practice Address - Phone:903-592-5934
Practice Address - Fax:903-597-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty