Provider Demographics
NPI:1891884052
Name:SMITH, JOHN DUNCAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DUNCAN
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1213 HERMANN DR
Mailing Address - Street 2:STE 250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7018
Mailing Address - Country:US
Mailing Address - Phone:713-942-8188
Mailing Address - Fax:713-942-9432
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:STE 250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-942-8188
Practice Address - Fax:713-942-9432
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122411223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD12241Medicare ID - Type Unspecified