Provider Demographics
NPI:1699407361
Name:SMITH, DUSTIN KYLE JR (DMD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:KYLE
Last Name:SMITH
Suffix:JR
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:CMR 405 BOX 5299
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09034-0053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FERN STREET 8653
Practice Address - Street 2:EU
Practice Address - City:BAUMHOLDER
Practice Address - State:GERMANY
Practice Address - Zip Code:55774
Practice Address - Country:DE
Practice Address - Phone:314-590-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10191122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist