Provider Demographics
NPI:1982632832
Name:SMITH, STEVEN J (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
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 1:3194 WALKER MILL CT
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3589
Mailing Address - Country:US
Mailing Address - Phone:801-266-4427
Mailing Address - Fax:801-266-9034
Practice Address - Street 1:6065 FASHION BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-7381
Practice Address - Country:US
Practice Address - Phone:801-266-4427
Practice Address - Fax:801-266-9034
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13674899221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice