Provider Demographics
NPI:1922269711
Name:J. ANTHONY SMITH DDS PA
Entity Type:Organization
Organization Name:J. ANTHONY SMITH DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-273-9444
Mailing Address - Street 1:550 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5402
Mailing Address - Country:US
Mailing Address - Phone:501-329-8754
Mailing Address - Fax:501-329-2530
Practice Address - Street 1:306 NE BLAKE ST STE 3
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5328
Practice Address - Country:US
Practice Address - Phone:479-273-9444
Practice Address - Fax:479-273-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR927261QD0000X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental