Healthcare Provider Details

I. General information

NPI: 1811106073
Provider Name (Legal Business Name): ROBERT R SMITH DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD SUITE 200
WEST HOLLYWOOD CA
90069-3701
US

IV. Provider business mailing address

9201 W SUNSET BLVD SUITE 200
WEST HOLLYWOOD CA
90069-3701
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-5775
  • Fax: 310-275-5454
Mailing address:
  • Phone: 310-273-5775
  • Fax: 310-275-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number21512
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT R SMITH
Title or Position: OWNER
Credential: DDS
Phone: 310-273-5775