Provider Demographics
NPI:1366609075
Name:RICHARD M. SMITH, DDS, PC
Entity type:Organization
Organization Name:RICHARD M. SMITH, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MADSEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-353-4361
Mailing Address - Street 1:3611 S GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4847
Mailing Address - Country:US
Mailing Address - Phone:806-353-4361
Mailing Address - Fax:806-353-4767
Practice Address - Street 1:3611 S GEORGIA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4847
Practice Address - Country:US
Practice Address - Phone:806-353-4361
Practice Address - Fax:806-353-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9826122300000X
TX21684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1903734-01Medicaid
TXG60178-1OtherTEXAS CHIP
TX0095648-01Medicaid
1023234606OtherNPI
1730305582OtherNPI