Provider Demographics
NPI:1134447923
Name:SMITH, WILLIAM G (DDS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:SMITH
Suffix:
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 1:132 DELAWARE STREET
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-1120
Mailing Address - Country:US
Mailing Address - Phone:607-865-4000
Mailing Address - Fax:607-865-4040
Practice Address - Street 1:132 DELAWARE STREET
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-1120
Practice Address - Country:US
Practice Address - Phone:607-865-4000
Practice Address - Fax:607-865-4040
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist