Provider Demographics
NPI:1982084968
Name:SMITH, RICHARD TYLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TYLER
Last Name:SMITH
Suffix:
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 1:301 N SHACKLEFORD RD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2843
Mailing Address - Country:US
Mailing Address - Phone:501-227-5155
Mailing Address - Fax:
Practice Address - Street 1:301 N SHACKLEFORD RD
Practice Address - Street 2:SUITE B1
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2843
Practice Address - Country:US
Practice Address - Phone:501-227-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR40411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice