Provider Demographics
NPI:1235351529
Name:SMITH, GREGORY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
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 1:420 E SOUTH TEMPLE STE 312
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1333
Mailing Address - Country:US
Mailing Address - Phone:801-955-1900
Mailing Address - Fax:
Practice Address - Street 1:420 E SOUTH TEMPLE STE 312
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1333
Practice Address - Country:US
Practice Address - Phone:801-955-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6245385-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice