Provider Demographics
NPI:1649265760
Name:SMITH, DAVID MEADE (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MEADE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 W FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-7200
Mailing Address - Country:US
Mailing Address - Phone:816-348-7527
Mailing Address - Fax:816-348-7987
Practice Address - Street 1:909 W FOXWOOD DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-7200
Practice Address - Country:US
Practice Address - Phone:816-348-7527
Practice Address - Fax:816-348-7987
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS65841223S0112X
MO20100156641223S0112X
MO20100073931223S0112X
KS04-347571223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery