Provider Demographics
NPI:1457335143
Name:SMITH, CURTIS L (DDS)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:L
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:PO BOX 30589
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73140-3589
Mailing Address - Country:US
Mailing Address - Phone:405-769-3301
Mailing Address - Fax:405-769-9685
Practice Address - Street 1:12716 NE 36TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OK
Practice Address - Zip Code:73084-9103
Practice Address - Country:US
Practice Address - Phone:405-769-3301
Practice Address - Fax:405-769-9685
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1229122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1229OtherDENTAL LICENSE
OK20177OtherBNDD
BS1463289OtherDEA
OK20177OtherBNDD