Healthcare Provider Details

I. General information

NPI: 1265458046
Provider Name (Legal Business Name): DAVID O SMITH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 S 700 E STE 204
SALT LAKE CITY UT
84102-1699
US

IV. Provider business mailing address

5 S 700 E STE 204
SALT LAKE CITY UT
84102-1699
US

V. Phone/Fax

Practice location:
  • Phone: 801-355-7021
  • Fax: 801-220-0510
Mailing address:
  • Phone: 801-355-7021
  • Fax: 801-220-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number020600578
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: