Healthcare Provider Details

I. General information

NPI: 1689700825
Provider Name (Legal Business Name): DEAN R SMART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 04/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E
MURRAY UT
84107-8100
US

IV. Provider business mailing address

11507 S 4055 W
SOUTH JORDAN UT
84009
US

V. Phone/Fax

Practice location:
  • Phone: 801-268-6900
  • Fax:
Mailing address:
  • Phone: 435-647-6884
  • Fax: 435-579-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number152719-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: