Healthcare Provider Details

I. General information

NPI: 1932250677
Provider Name (Legal Business Name): DAMON LOYD SMITH D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 N GARNETT RD SUITE E
OWASSO OK
74055-4452
US

IV. Provider business mailing address

9100 N GARNETT RD SUITE E
OWASSO OK
74055-4452
US

V. Phone/Fax

Practice location:
  • Phone: 918-272-4704
  • Fax: 918-272-4903
Mailing address:
  • Phone: 918-272-4704
  • Fax: 918-272-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number2883
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: