Healthcare Provider Details

I. General information

NPI: 1508800749
Provider Name (Legal Business Name): CHESTER KEMP SMYTH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 E MOSS CREEK DR
MURRAY UT
84107-4230
US

IV. Provider business mailing address

492 E MOSS CREEK DR
MURRAY UT
84107-4230
US

V. Phone/Fax

Practice location:
  • Phone: 801-694-7161
  • Fax:
Mailing address:
  • Phone: 801-694-7161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number136760
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: