Healthcare Provider Details

I. General information

NPI: 1083713887
Provider Name (Legal Business Name): DAVE L. SMITH D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 W SAHARA AVE SUITE 4
LAS VEGAS NV
89146-3306
US

IV. Provider business mailing address

5320 W SAHARA AVE SUITE 4
LAS VEGAS NV
89146-3306
US

V. Phone/Fax

Practice location:
  • Phone: 702-871-1808
  • Fax: 702-871-3767
Mailing address:
  • Phone: 702-871-1808
  • Fax: 702-871-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3082
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: