Provider Demographics
NPI:1124126263
Name:SMITH, JUSTEN BRENT (DDS)
Entity type:Individual
Prefix:MR
First Name:JUSTEN
Middle Name:BRENT
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 1:5031 E 116TH ST N
Mailing Address - Street 2:
Mailing Address - City:SPERRY
Mailing Address - State:OK
Mailing Address - Zip Code:74073-4199
Mailing Address - Country:US
Mailing Address - Phone:918-288-7695
Mailing Address - Fax:918-288-7695
Practice Address - Street 1:5031 E 116TH ST N
Practice Address - Street 2:
Practice Address - City:SPERRY
Practice Address - State:OK
Practice Address - Zip Code:74073-4199
Practice Address - Country:US
Practice Address - Phone:918-288-7695
Practice Address - Fax:918-288-7695
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist