Provider Demographics
NPI:1841388188
Name:SMITH, ALLEN TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:TODD
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 SOUTH HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4127
Mailing Address - Country:US
Mailing Address - Phone:336-765-9550
Mailing Address - Fax:336-765-9552
Practice Address - Street 1:1601 SOUTH HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4127
Practice Address - Country:US
Practice Address - Phone:336-765-9550
Practice Address - Fax:336-765-9552
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5848204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997869Medicaid
NC2428626Medicare ID - Type Unspecified
U50504Medicare UPIN