Provider Demographics
NPI:1659862555
Name:SMUIN, DALLAS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:MICHAEL
Last Name:SMUIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 GUSDORF RD STE A
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6499
Mailing Address - Country:US
Mailing Address - Phone:575-758-0009
Mailing Address - Fax:
Practice Address - Street 1:1219 GUSDORF RD STE A
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6499
Practice Address - Country:US
Practice Address - Phone:575-758-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT215025207X00000X
PAMD471072207X00000X
NMMD2023-0551207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery