Provider Demographics
NPI:1730289083
Name:SMART, DENISE SYLVIE (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:SYLVIE
Last Name:SMART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 POPE AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3524
Mailing Address - Country:US
Mailing Address - Phone:415-308-6489
Mailing Address - Fax:916-571-5263
Practice Address - Street 1:3401 POPE AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3524
Practice Address - Country:US
Practice Address - Phone:415-308-6489
Practice Address - Fax:916-571-5263
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39702207Y00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A28950Medicare UPIN
CA00A397020Medicare ID - Type Unspecified