Provider Demographics
NPI:1881817740
Name:SMITH, LATONIA SHANTE (DDS)
Entity type:Individual
Prefix:DR
First Name:LATONIA
Middle Name:SHANTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 OSLER DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1064
Mailing Address - Country:US
Mailing Address - Phone:979-595-7276
Mailing Address - Fax:972-641-5448
Practice Address - Street 1:2701 OSLER DR
Practice Address - Street 2:SUITE 10
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1064
Practice Address - Country:US
Practice Address - Phone:979-595-7276
Practice Address - Fax:972-641-5448
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154467801Medicaid
TX154467803Medicaid
TX154467801Medicaid
TX451942Medicare Oscar/Certification