Provider Demographics
NPI:1467668541
Name:SMITH, PHILIP LEE (DMD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MCMAHON PL
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1700
Mailing Address - Country:US
Mailing Address - Phone:845-628-3197
Mailing Address - Fax:845-628-1161
Practice Address - Street 1:10 MCMAHON PL
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1700
Practice Address - Country:US
Practice Address - Phone:845-628-3197
Practice Address - Fax:845-628-1161
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0465651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice