Healthcare Provider Details

I. General information

NPI: 1598785974
Provider Name (Legal Business Name): JAMES D SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S STERLING AVE
SUGAR CREEK MO
64054
US

IV. Provider business mailing address

104 S STERLING AVE
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:
Title or Position:
Credential:
Phone: