Healthcare Provider Details

I. General information

NPI: 1598806648
Provider Name (Legal Business Name): CRAIG C SMITH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5373 S GREEN ST 4TH FLOOR
SALT LAKE CITY UT
84123-4680
US

IV. Provider business mailing address

5373 S GREEN ST 4TH FLOOR
SALT LAKE CITY UT
84123-4680
US

V. Phone/Fax

Practice location:
  • Phone: 801-313-7097
  • Fax: 801-290-5136
Mailing address:
  • Phone: 801-313-7097
  • Fax: 801-290-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number316100
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: