Provider Demographics
NPI:1922791060
Name:SMITH, STEPHEN K (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 E 1625 N
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-3402
Mailing Address - Country:US
Mailing Address - Phone:801-628-8737
Mailing Address - Fax:
Practice Address - Street 1:2797 N HIGHWAY 89 STE 201
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-1231
Practice Address - Country:US
Practice Address - Phone:385-324-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13430091-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice