Provider Demographics
NPI:1295823367
Name:SMITH, MICHAEL TODD (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
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 1:2180 E 4500 S STE 225
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4029
Mailing Address - Country:US
Mailing Address - Phone:801-278-4431
Mailing Address - Fax:801-278-4436
Practice Address - Street 1:2180 E 4500 S STE 225
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4029
Practice Address - Country:US
Practice Address - Phone:801-278-4431
Practice Address - Fax:801-278-4436
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT24632951223G0001X
AK15521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice