Healthcare Provider Details

I. General information

NPI: 1619333663
Provider Name (Legal Business Name): CHAD SMITH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 LAKE PLAZA DR STE 200
COLORADO SPRINGS CO
80906-3515
US

IV. Provider business mailing address

1275 LAKE PLAZA DR STE 200
COLORADO SPRINGS CO
80906-3515
US

V. Phone/Fax

Practice location:
  • Phone: 719-301-1119
  • Fax: 719-301-1131
Mailing address:
  • Phone: 719-301-1119
  • Fax: 719-301-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number203034
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: