Provider Demographics
NPI:1164567335
Name:SMITH, STEPHEN FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FREDERICK
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 1:563 BRUNSWICK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9544
Mailing Address - Country:US
Mailing Address - Phone:530-273-4442
Mailing Address - Fax:530-272-3042
Practice Address - Street 1:563 BRUNSWICK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9544
Practice Address - Country:US
Practice Address - Phone:530-273-4442
Practice Address - Fax:530-272-3042
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD21407122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist