Provider Demographics
NPI:1346862539
Name:SMITH, KENTON JEFFREY (DMD)
Entity Type:Individual
Prefix:
First Name:KENTON
Middle Name:JEFFREY
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 70TH ST W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1618
Mailing Address - Country:US
Mailing Address - Phone:406-697-6351
Mailing Address - Fax:
Practice Address - Street 1:10 AVANTA WAY STE 3
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6874
Practice Address - Country:US
Practice Address - Phone:406-655-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-192981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice