Provider Demographics
NPI:1942973250
Name:SMITH, ANTHONY DWIGHT JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DWIGHT
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 1:4806 STAGE LINE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1122
Mailing Address - Country:US
Mailing Address - Phone:817-489-8429
Mailing Address - Fax:
Practice Address - Street 1:900 E COPELAND RD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-1392
Practice Address - Country:US
Practice Address - Phone:817-672-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice