Provider Demographics
NPI:1922104413
Name:SMITH, ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
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 1:18935 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2273
Mailing Address - Country:US
Mailing Address - Phone:313-835-8280
Mailing Address - Fax:313-835-2879
Practice Address - Street 1:18935 GRAND RIVER
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-0000
Practice Address - Country:US
Practice Address - Phone:313-835-8280
Practice Address - Fax:313-835-2879
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13513122300000X
TX243021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1958213670OtherBCBS PIN