Healthcare Provider Details

I. General information

NPI: 1194392399
Provider Name (Legal Business Name): HARRISON BAKER SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 S ROUSE ST
PITTSBURG KS
66762-6629
US

IV. Provider business mailing address

803 S 39TH ST
SAINT JOSEPH MO
64507-2145
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-2871
  • Fax:
Mailing address:
  • Phone: 913-940-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number62066
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2021019531
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: