Provider Demographics
NPI:1932445715
Name:SMITH, STEPHEN CHRISTOPHER (DN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHRISTOPHER
Last Name:SMITH
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S WATTERS RD
Mailing Address - Street 2:#216
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6515
Mailing Address - Country:US
Mailing Address - Phone:214-789-8035
Mailing Address - Fax:
Practice Address - Street 1:300 S WATTERS RD
Practice Address - Street 2:#216
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6515
Practice Address - Country:US
Practice Address - Phone:214-789-8035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-22
Last Update Date:2012-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5900133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered