Provider Demographics
NPI:1063416675
Name:SMITH, PAUL G (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1630 E HIGH ST
Mailing Address - Street 2:BLDG 4
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3244
Mailing Address - Country:US
Mailing Address - Phone:610-326-7880
Mailing Address - Fax:610-326-5491
Practice Address - Street 1:1630 E HIGH ST
Practice Address - Street 2:BLDG 4
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3244
Practice Address - Country:US
Practice Address - Phone:610-326-7880
Practice Address - Fax:610-326-5491
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-027072L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001362OtherDORAL DENTAL
PA0450572000OtherKEYSTONE HEALTH PLAN EAST
PA1244005-005OtherCIGNA
PWSM621130OtherHIGHMARK
PA0068555OtherAETNA HMO
PA03208601OtherCAPITAL BLUE CROSS
PA4273120OtherAETNA COMMERCIAL PLANS
PA4273120OtherAETNA COMMERCIAL PLANS
PWT98342Medicare UPIN