Provider Demographics
NPI:1891831491
Name:SMITH, GREGORY EUGENE (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:EUGENE
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 1:6116 N CENTRAL EXPWY
Mailing Address - Street 2:STE 611
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5134
Mailing Address - Country:US
Mailing Address - Phone:214-361-7060
Mailing Address - Fax:214-361-7072
Practice Address - Street 1:6116 N CENTRAL EXPWY
Practice Address - Street 2:STE 611
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5134
Practice Address - Country:US
Practice Address - Phone:214-361-7060
Practice Address - Fax:214-361-7072
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13812122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist