Provider Demographics
NPI:1477649580
Name:SMITH, CAROL (DDS)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6377 W IRMA LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6611
Mailing Address - Country:US
Mailing Address - Phone:623-572-1381
Mailing Address - Fax:
Practice Address - Street 1:13925 W MEEKER BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4430
Practice Address - Country:US
Practice Address - Phone:623-556-5006
Practice Address - Fax:623-556-5564
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics