Provider Demographics
NPI:1083713887
Name:SMITH, DAVE L (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 W SAHARA AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3306
Mailing Address - Country:US
Mailing Address - Phone:702-871-1808
Mailing Address - Fax:702-871-3767
Practice Address - Street 1:5320 W SAHARA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3306
Practice Address - Country:US
Practice Address - Phone:702-871-1808
Practice Address - Fax:702-871-3767
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV30821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics