Healthcare Provider Details

I. General information

NPI: 1245296821
Provider Name (Legal Business Name): SMITH DENTAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 FT LARNEL AVE
LARNEL KS
67550
US

IV. Provider business mailing address

PO BOX 36
LARNEL KS
67550
US

V. Phone/Fax

Practice location:
  • Phone: 620-285-6531
  • Fax: 620-285-6573
Mailing address:
  • Phone: 620-285-6531
  • Fax: 620-285-6573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. TRENT D SMITH
Title or Position: DENTIST
Credential: DDS
Phone: 620-285-6531