Provider Demographics
NPI:1952483976
Name:SMITH, MICHAEL G (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 E WARNER RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3550
Mailing Address - Country:US
Mailing Address - Phone:480-839-0330
Mailing Address - Fax:480-839-8413
Practice Address - Street 1:2161 E WARNER RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3550
Practice Address - Country:US
Practice Address - Phone:480-839-0330
Practice Address - Fax:480-839-8413
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice