Provider Demographics
NPI:1811132194
Name:G. BENNETT SMITH, DDS & LYNETTE L. SMITH, DDS, PA
Entity type:Organization
Organization Name:G. BENNETT SMITH, DDS & LYNETTE L. SMITH, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-789-5306
Mailing Address - Street 1:933 OLD ROCKFORD ST
Mailing Address - Street 2:SUITE #7
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5356
Mailing Address - Country:US
Mailing Address - Phone:336-789-5306
Mailing Address - Fax:336-789-3311
Practice Address - Street 1:933 OLD ROCKFORD ST
Practice Address - Street 2:SUITE #7
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5356
Practice Address - Country:US
Practice Address - Phone:336-789-5306
Practice Address - Fax:336-789-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCN/A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental