Provider Demographics
NPI:1063449544
Name:SMITH JR., MAX D (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:D
Last Name:SMITH JR.
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 1:8787 BALLENTINE
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214
Mailing Address - Country:US
Mailing Address - Phone:913-888-9300
Mailing Address - Fax:913-541-1108
Practice Address - Street 1:8787 BALLENTINE
Practice Address - Street 2:SUITE 2100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214
Practice Address - Country:US
Practice Address - Phone:913-888-9300
Practice Address - Fax:913-541-1108
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO124461223S0112X
KS56171223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T81810Medicare UPIN
C656076Medicare ID - Type Unspecified