Provider Demographics
NPI:1801815204
Name:SMITH, ERIC S (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E 3900 S
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1475
Mailing Address - Country:US
Mailing Address - Phone:801-273-0260
Mailing Address - Fax:801-273-0269
Practice Address - Street 1:1401 E 3900 S
Practice Address - Street 2:SUITE 204
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1475
Practice Address - Country:US
Practice Address - Phone:801-273-0260
Practice Address - Fax:801-273-0269
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5130516-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice