Provider Demographics
NPI:1134537137
Name:SMART, TREVOR (DMD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:
Last Name:SMART
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 1:77 GILCREAST RD STE 1004
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3518
Mailing Address - Country:US
Mailing Address - Phone:315-521-8162
Mailing Address - Fax:
Practice Address - Street 1:77 GILCREAST RD STE 1004
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3518
Practice Address - Country:US
Practice Address - Phone:603-434-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist