Healthcare Provider Details

I. General information

NPI: 1609484807
Provider Name (Legal Business Name): RYAN ADAM SMITH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 SHERIDAN ST
HOLLYWOOD FL
33021-3511
US

IV. Provider business mailing address

4468 SPRUCE LN
OAKLAND PARK FL
33309-3634
US

V. Phone/Fax

Practice location:
  • Phone: 754-263-2433
  • Fax:
Mailing address:
  • Phone: 954-830-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number25138
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: