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General NPI Number Information
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NPI Number | 1053626671
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Entity Type | Individual
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Provider Name | NICHOLAS A SMITH DMD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 2074 S 6TH ST
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-3372
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Country | US
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Telephone | 541-880-2090
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Fax | 541-880-2092
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Provider Business Mailing Address
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Address Line | 202 SOUTHSHORE LN
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City | KLAMATH FALLS
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State | OR
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Zip | 97601-9111
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Country | US
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Telephone | 971-678-4741
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D9464
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License Number State | OR
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