Provider Demographics
NPI:1235392770
Name:SMITH, TREVOR PARKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:PARKER
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 1:370 N HAVEN DR STE 103
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6023
Mailing Address - Country:US
Mailing Address - Phone:208-268-0111
Mailing Address - Fax:208-268-0125
Practice Address - Street 1:370 N HAVEN DR STE 103
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6023
Practice Address - Country:US
Practice Address - Phone:208-268-0111
Practice Address - Fax:208-268-0125
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4351-PD1223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry