Provider Demographics
NPI:1467413443
Name:SMITH, TRENT D
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 FT LARNED AVE
Mailing Address - Street 2:BOX 36
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550
Mailing Address - Country:US
Mailing Address - Phone:620-285-6531
Mailing Address - Fax:620-285-6753
Practice Address - Street 1:706 FT LARNED AVE
Practice Address - Street 2:BOX 36
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550
Practice Address - Country:US
Practice Address - Phone:620-285-6531
Practice Address - Fax:620-285-6753
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
59826OtherBCBS