Healthcare Provider Details

I. General information

NPI: 1104822378
Provider Name (Legal Business Name): STANLEY JAMES SMITH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 S MASON RD STE 215
KATY TX
77450-3857
US

IV. Provider business mailing address

810 S MASON RD STE 215
KATY TX
77450-3857
US

V. Phone/Fax

Practice location:
  • Phone: 281-395-2112
  • Fax: 281-395-4706
Mailing address:
  • Phone: 281-395-2112
  • Fax: 281-395-4706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9827
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: