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General NPI Number Information
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NPI Number | 1154636033
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Entity Type | Individual
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Provider Name | ALLEN DENE SMITH DDS
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Gender | Male
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 45 CAPRI BLVD SUITE G
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City | LAKE HAVASU
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State | AZ
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Zip | 86403-5657
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Country | US
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Telephone | 650-291-0068
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Fax |
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Provider Business Mailing Address
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Address Line | 45 CAPRI BLVD SUITE G
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City | LAKE HAVASU
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State | AZ
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Zip | 86403-5657
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Country | US
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Telephone | 650-291-0068
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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 | 30-023313
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D010799
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License Number State | AZ
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