Provider Demographics
NPI:1922023290
Name:SMITH, DWIGHT STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:STEPHEN
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 1:2300 WAYNE MEMORIAL DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1726
Mailing Address - Country:US
Mailing Address - Phone:919-734-3564
Mailing Address - Fax:919-734-3797
Practice Address - Street 1:2300 WAYNE MEMORIAL DR
Practice Address - Street 2:SUITE F
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1726
Practice Address - Country:US
Practice Address - Phone:919-734-3564
Practice Address - Fax:919-734-3797
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 42571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997894Medicaid
NC8997894Medicaid