Provider Demographics
NPI:1902981319
Name:ROBERT G. SMITH, DDS, CHTD.
Entity Type:Organization
Organization Name:ROBERT G. SMITH, DDS, CHTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUS. MNGR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-649-5600
Mailing Address - Street 1:3700 W 83RD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5121
Mailing Address - Country:US
Mailing Address - Phone:913-649-5600
Mailing Address - Fax:913-649-2069
Practice Address - Street 1:3700 W 83RD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5121
Practice Address - Country:US
Practice Address - Phone:913-649-5600
Practice Address - Fax:913-649-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS49361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty