Healthcare Provider Details

I. General information

NPI: 1407863632
Provider Name (Legal Business Name): DREW G. SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3277 WHITE MOUNTAIN HWY
NORTH CONWAY NH
03860-5113
US

IV. Provider business mailing address

PO BOX 1289
NORTH CONWAY NH
03860-1289
US

V. Phone/Fax

Practice location:
  • Phone: 603-356-9755
  • Fax: 603-356-9754
Mailing address:
  • Phone: 603-356-9755
  • Fax: 603-356-9754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2429
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: