Provider Demographics
NPI:1295713402
Name:SMITH, WILLIAM LESTER JR (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LESTER
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 1:200 BETTY ST
Mailing Address - Street 2:
Mailing Address - City:EYNON
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1224
Mailing Address - Country:US
Mailing Address - Phone:570-876-4719
Mailing Address - Fax:570-876-5036
Practice Address - Street 1:200 BETTY ST
Practice Address - Street 2:
Practice Address - City:EYNON
Practice Address - State:PA
Practice Address - Zip Code:18403-1224
Practice Address - Country:US
Practice Address - Phone:570-876-4719
Practice Address - Fax:570-876-5036
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0193791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice