Provider Demographics
NPI:1699714196
Name:SMITH, CARMEN PRINCELE (DDS)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:PRINCELE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9310 FOREST LN
Mailing Address - Street 2:SUITE 338
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4219
Mailing Address - Country:US
Mailing Address - Phone:214-503-6776
Mailing Address - Fax:214-503-6733
Practice Address - Street 1:9310 FOREST LN
Practice Address - Street 2:SUITE 338
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4219
Practice Address - Country:US
Practice Address - Phone:214-503-6776
Practice Address - Fax:214-503-6733
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice