Provider Demographics
NPI:1255794087
Name:ASHLEY M. SMITHERMAN, DDS, PLLC
Entity type:Organization
Organization Name:ASHLEY M. SMITHERMAN, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:979-777-3258
Mailing Address - Street 1:4631 AIRPORT BLVD
Mailing Address - Street 2:STE 120A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3453
Mailing Address - Country:US
Mailing Address - Phone:979-777-3258
Mailing Address - Fax:
Practice Address - Street 1:4631 AIRPORT BLVD
Practice Address - Street 2:STE 120A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3453
Practice Address - Country:US
Practice Address - Phone:979-777-3258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0221X
TX281871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty