Provider Demographics
NPI:1932499217
Name:SMITH, SHAUN LOCKSLEY (DDS PLLC)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:LOCKSLEY
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8223 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071
Mailing Address - Country:US
Mailing Address - Phone:954-368-0105
Mailing Address - Fax:954-526-1747
Practice Address - Street 1:8223 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071
Practice Address - Country:US
Practice Address - Phone:954-368-0105
Practice Address - Fax:954-526-1747
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14770122300000X
DCDEN1000968122300000X
VA04014130141223X0400X
FLDN230951223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist