Provider Demographics
NPI:1619016060
Name:SMETKO, CARL STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:STEVEN
Last Name:SMETKO
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 1:720 N TUSTIN AVENUE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-543-8396
Mailing Address - Fax:714-543-2190
Practice Address - Street 1:720 N TUSTIN AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-543-8396
Practice Address - Fax:714-543-2190
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD218331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice