Healthcare Provider Details

I. General information

NPI: 1891947594
Provider Name (Legal Business Name): DARRELL GEORGE SMITH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 WEST LOGAN HIGHWAY
GARDEN CITY UT
84028
US

IV. Provider business mailing address

2455 E 3750 N
LAYTON UT
84040-8431
US

V. Phone/Fax

Practice location:
  • Phone: 801-928-4579
  • Fax:
Mailing address:
  • Phone: 801-928-4579
  • Fax: 801-771-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number131952-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: