Provider Demographics
NPI:1598785974
Name:SMITH, JAMES D (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
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 1:104 S STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR CREEK
Mailing Address - State:MO
Mailing Address - Zip Code:64054
Mailing Address - Country:US
Mailing Address - Phone:816-254-6557
Mailing Address - Fax:816-254-6550
Practice Address - Street 1:104 S STERLING AVE
Practice Address - Street 2:
Practice Address - City:SUGAR CREEK
Practice Address - State:MO
Practice Address - Zip Code:64054
Practice Address - Country:US
Practice Address - Phone:816-254-6557
Practice Address - Fax:816-254-6550
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO127711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice