Provider Demographics
NPI:1629150073
Name:PARKER SMART, JAN DIANE (DDS)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:DIANE
Last Name:PARKER SMART
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 1:7180 E ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1724
Mailing Address - Country:US
Mailing Address - Phone:303-741-9949
Mailing Address - Fax:303-741-9969
Practice Address - Street 1:7180 E ORCHARD RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1724
Practice Address - Country:US
Practice Address - Phone:303-741-9949
Practice Address - Fax:303-741-9969
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO60571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6057OtherSTATE LICENSE