Provider Demographics
NPI:1053572339
Name:SMITH, PAUL BRYANT (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRYANT
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 1:2815 W LAKE HOUSTON PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5220
Mailing Address - Country:US
Mailing Address - Phone:281-360-5646
Mailing Address - Fax:281-360-8439
Practice Address - Street 1:2815 W LAKE HOUSTON PKWY STE 110
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5220
Practice Address - Country:US
Practice Address - Phone:281-360-5646
Practice Address - Fax:281-360-8439
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice