Healthcare Provider Details

I. General information

NPI: 1376596189
Provider Name (Legal Business Name): LEONARD WILTON SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MEDI PARK SUITE 215
AMARILLO TX
79106-2110
US

IV. Provider business mailing address

1901 MEDI PARK STE 215
AMARILLO TX
79106-2110
US

V. Phone/Fax

Practice location:
  • Phone: 806-353-2111
  • Fax: 806-354-8277
Mailing address:
  • Phone: 806-353-2111
  • Fax: 806-354-8277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number9549
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number9549
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: