Healthcare Provider Details

I. General information

NPI: 1699065243
Provider Name (Legal Business Name): DALLAS CHRISTOPHER SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2011
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13555 W MCDOWELL RD STE 201
GOODYEAR AZ
85395-2624
US

IV. Provider business mailing address

20280 N 59TH AVE STE 115-617
GLENDALE AZ
85308-6850
US

V. Phone/Fax

Practice location:
  • Phone: 602-795-8700
  • Fax: 602-795-8701
Mailing address:
  • Phone: 602-795-8700
  • Fax: 602-795-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number006966
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: