Healthcare Provider Details

I. General information

NPI: 1326777699
Provider Name (Legal Business Name): NICHOLAS SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 SHEPARD LN STE 100
FARMINGTON UT
84025-2973
US

IV. Provider business mailing address

728 CHELSIE DR
KAYSVILLE UT
84037-9587
US

V. Phone/Fax

Practice location:
  • Phone: 801-447-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number133449269926
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13344926-9925
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: