Provider Demographics
NPI:1972507655
Name:SMITH, DALLAS AARON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:AARON
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4778
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27404-4778
Mailing Address - Country:US
Mailing Address - Phone:336-542-2900
Mailing Address - Fax:336-542-2929
Practice Address - Street 1:109 MUIRS CHAPEL RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6161
Practice Address - Country:US
Practice Address - Phone:336-852-3300
Practice Address - Fax:336-387-2165
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC209652085N0700X, 2085N0904X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00725388OtherRAILROAD MEDICARE
NC8977458Medicaid
NC8977458Medicaid
NCP00725388OtherRAILROAD MEDICARE