Healthcare Provider Details

I. General information

NPI: 1447579230
Provider Name (Legal Business Name): DAVID M SMITH DDS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W FOXWOOD DR
RAYMORE MO
64083-7200
US

IV. Provider business mailing address

3000 UNITED FOUNDERS BLVD SUITE 237
OKLAHOMA CITY OK
73112-3958
US

V. Phone/Fax

Practice location:
  • Phone: 405-848-7974
  • Fax: 405-848-0033
Mailing address:
  • Phone: 405-848-7974
  • Fax: 405-848-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2010007393
License Number StateMO

VIII. Authorized Official

Name: KATHY DRESHER
Title or Position: VP OF BILLING
Credential:
Phone: 405-848-7974