Provider Demographics
NPI:1275926362
Name:SMITHDMD
Entity Type:Organization
Organization Name:SMITHDMD
Other - Org Name:DAVIS DENTAL CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:DALAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-849-1914
Mailing Address - Street 1:1133 N MAIN ST
Mailing Address - Street 2:LOWER MEZZANINE
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4800
Mailing Address - Country:US
Mailing Address - Phone:801-546-0931
Mailing Address - Fax:
Practice Address - Street 1:1133 N MAIN ST
Practice Address - Street 2:LOWER MEZZANINE
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4800
Practice Address - Country:US
Practice Address - Phone:801-546-0931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4909855-9922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental