Provider Demographics
NPI:1770636383
Name:SMITH, JOHN P (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1011 N CRAYCROFT RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-7309
Mailing Address - Country:US
Mailing Address - Phone:520-322-0800
Mailing Address - Fax:520-917-2358
Practice Address - Street 1:1011 N CRAYCROFT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-7309
Practice Address - Country:US
Practice Address - Phone:520-322-0800
Practice Address - Fax:520-917-2358
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZD45201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics