Provider Demographics
NPI:1912949066
Name:SMITH, JOSEPH ROY II (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROY
Last Name:SMITH
Suffix:II
Gender:M
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:NC
Mailing Address - Zip Code:27812-0936
Mailing Address - Country:US
Mailing Address - Phone:252-825-1131
Mailing Address - Fax:252-825-0220
Practice Address - Street 1:3877 JAMES ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:NC
Practice Address - Zip Code:27812-0018
Practice Address - Country:US
Practice Address - Phone:252-825-1131
Practice Address - Fax:252-825-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997937Medicaid