Provider Demographics
NPI:1699876060
Name:SMITH, ROBERT LEE (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
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 1:2597 MCFADDIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1618
Mailing Address - Country:US
Mailing Address - Phone:409-832-4262
Mailing Address - Fax:409-832-6652
Practice Address - Street 1:2597 MCFADDIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1618
Practice Address - Country:US
Practice Address - Phone:409-832-4262
Practice Address - Fax:409-832-6652
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist