Provider Demographics
NPI:1922018662
Name:SMITH, GERALD W (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:W
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 1:8680 W MAIN ST STE 4E
Mailing Address - Street 2:PO BOX 516
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3096
Mailing Address - Country:US
Mailing Address - Phone:972-335-2417
Mailing Address - Fax:972-377-3808
Practice Address - Street 1:8680 W MAIN ST STE 4E
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3096
Practice Address - Country:US
Practice Address - Phone:972-335-2417
Practice Address - Fax:972-377-3808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J565OtherBLUE CROSS BLUE SHIELD
TX810437OtherUNITED CONCORDIA