Healthcare Provider Details

I. General information

NPI: 1225955115
Provider Name (Legal Business Name): KATIE SMITH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40158 MEDFORD RD
TEMECULA CA
92591-3548
US

IV. Provider business mailing address

40158 MEDFORD RD
TEMECULA CA
92591-3548
US

V. Phone/Fax

Practice location:
  • Phone: 951-225-2537
  • Fax:
Mailing address:
  • Phone: 951-225-2537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: