Healthcare Provider Details

I. General information

NPI: 1508011099
Provider Name (Legal Business Name): JAMES D. SMITH DDS, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S. STERLING
SUGAR CREEK MO
64054
US

IV. Provider business mailing address

104 S. STERLING
SUGAR CREEK MO
64054
US

V. Phone/Fax

Practice location:
  • Phone: 816-254-6557
  • Fax: 816-254-6550
Mailing address:
  • Phone: 816-254-6557
  • Fax: 816-254-6550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12771
License Number StateMO

VIII. Authorized Official

Name: JAMES D. SMITH
Title or Position: DENTIST
Credential: D.D.S., L.L.C.
Phone: 816-254-6557