Healthcare Provider Details

I. General information

NPI: 1649074964
Provider Name (Legal Business Name): LUKE SMITH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W D.L. INGRAM AVE
CANNON AFB NM
88101
US

IV. Provider business mailing address

104 W D.L. INGRAM AVE
CANNON AFB NM
88101
US

V. Phone/Fax

Practice location:
  • Phone: 575-784-4041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8210
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDB-2026-0225
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: