Provider Demographics
NPI:1346526233
Name:SMITH FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:SMITH FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-889-7835
Mailing Address - Street 1:3230 E BASELINE RD # 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7114
Mailing Address - Country:US
Mailing Address - Phone:602-889-7835
Mailing Address - Fax:602-889-7840
Practice Address - Street 1:3230 E BASELINE RD # 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-7114
Practice Address - Country:US
Practice Address - Phone:602-889-7835
Practice Address - Fax:602-889-7840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7760305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization