Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 9549 | TX |
N | 1223P0300X | Periodontist | 9549 | TX |
NPI | 1376596189 |
---|---|
Provider Name | Dr. Leonard Wilton Smith |
First Address | Amarillo, TX 79106-2110 |
Second Address | Amarillo, TX 79106-2110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |