Healthcare Provider Details

I. General information

NPI: 1689584419
Provider Name (Legal Business Name): DAWAN SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17200 E ILIFF AVE STE A12
AURORA CO
80013-5804
US

IV. Provider business mailing address

17200 E ILIFF AVE STE A12
AURORA CO
80013-5804
US

V. Phone/Fax

Practice location:
  • Phone: 720-468-2306
  • Fax:
Mailing address:
  • Phone: 720-468-2306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number0100204
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: