Provider Demographics
NPI:1356403760
Name:SMALLWOOD, TRENT WISLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:WISLEY
Last Name:SMALLWOOD
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 1:420 W WARNER RD
Mailing Address - Street 2:ST. #101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2960
Mailing Address - Country:US
Mailing Address - Phone:480-894-8101
Mailing Address - Fax:
Practice Address - Street 1:420 W WARNER RD
Practice Address - Street 2:ST. #101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2960
Practice Address - Country:US
Practice Address - Phone:480-894-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD47071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice