Healthcare Provider Details

I. General information

NPI: 1972825685
Provider Name (Legal Business Name): SMITH PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 2ND AVE W
WILLISTON ND
58801-3485
US

IV. Provider business mailing address

5594 W 9660 N
HIGHLAND UT
84003-4809
US

V. Phone/Fax

Practice location:
  • Phone: 701-360-7510
  • Fax:
Mailing address:
  • Phone: 801-885-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5602607-9923
License Number StateUT

VIII. Authorized Official

Name: NATHAN ENGLAND SMITH
Title or Position: OWNER
Credential: DDS
Phone: 801-885-2703