Provider Demographics
NPI:1932296886
Name:SMITH, BENJAMIN EVANS JR (DDS)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:EVANS
Last Name:SMITH
Suffix:JR
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 1:17240 MILL FOREST LN
Mailing Address - Street 2:STE B
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4366
Mailing Address - Country:US
Mailing Address - Phone:281-280-8111
Mailing Address - Fax:281-280-8525
Practice Address - Street 1:17240 MILL FOREST LN
Practice Address - Street 2:STE B
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4366
Practice Address - Country:US
Practice Address - Phone:281-280-8111
Practice Address - Fax:281-280-8525
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84D541OtherBCBS
121808OtherUNITED CONCORDIA