Healthcare Provider Details

I. General information

NPI: 1477543353
Provider Name (Legal Business Name): DAVID E. SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40285 WINCHESTER RD SUITE 101
TEMECULA CA
92591-5547
US

IV. Provider business mailing address

40285 WINCHESTER RD SUITE 101
TEMECULA CA
92591-5547
US

V. Phone/Fax

Practice location:
  • Phone: 951-296-5100
  • Fax: 951-286-5103
Mailing address:
  • Phone: 951-296-5100
  • Fax: 951-286-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number34562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: