Provider Demographics
NPI:1366430043
Name:SMITH, AHSLEY W (DMD)
Entity type:Individual
Prefix:
First Name:AHSLEY
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HIDALGO MEDICAL SERVICES
Mailing Address - Street 2:530 DEMOSS STREET
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-2632
Mailing Address - Country:US
Mailing Address - Phone:505-542-8384
Mailing Address - Fax:505-542-8387
Practice Address - Street 1:HIDALGO MEDICAL SERVICES
Practice Address - Street 2:530 DEMOSS STREET
Practice Address - City:LORDSBURG
Practice Address - State:NM
Practice Address - Zip Code:88045-2632
Practice Address - Country:US
Practice Address - Phone:505-542-8384
Practice Address - Fax:505-542-8387
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD26401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87422875Medicaid