Healthcare Provider Details

I. General information

NPI: 1518982040
Provider Name (Legal Business Name): STEPHEN C. SMITH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 SOQUEL DR
APTOS CA
95003-3198
US

IV. Provider business mailing address

P.O. BOX 221993
CARMEL CA
93922
US

V. Phone/Fax

Practice location:
  • Phone: 831-479-6431
  • Fax:
Mailing address:
  • Phone: 831-626-5900
  • Fax: 831-626-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number38463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: