Provider Demographics
NPI:1801921606
Name:SMITH, EDWARD THOMPSON JR (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:THOMPSON
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-6275
Mailing Address - Country:US
Mailing Address - Phone:336-476-6129
Mailing Address - Fax:336-476-3254
Practice Address - Street 1:210 ARTHUR DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-6275
Practice Address - Country:US
Practice Address - Phone:336-476-6129
Practice Address - Fax:336-476-3254
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC44041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997899Medicaid