Provider Demographics
NPI:1295743326
Name:SMITH, MICHAEL RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
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 1:6302 BROADWAY ST
Mailing Address - Street 2:SUITE # 150
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7856
Mailing Address - Country:US
Mailing Address - Phone:281-997-0100
Mailing Address - Fax:281-997-0680
Practice Address - Street 1:6302 BROADWAY ST
Practice Address - Street 2:SUITE # 150
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7856
Practice Address - Country:US
Practice Address - Phone:281-997-0100
Practice Address - Fax:281-997-0680
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1773061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice