Provider Demographics
NPI:1437590668
Name:SMITH, GAVYN CHRISTIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAVYN
Middle Name:CHRISTIAN
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 1:6544 W 10380 N
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-6704
Mailing Address - Country:US
Mailing Address - Phone:801-636-6730
Mailing Address - Fax:
Practice Address - Street 1:6544 W 10380 N
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-6704
Practice Address - Country:US
Practice Address - Phone:801-636-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8710807-9921122300000X
UT87108071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist