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General NPI Number Information
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NPI Number | 1174177281
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Entity Type | Organization
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Legal Business Name | GRANT R SMITH DDS PA
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 3700 W 83RD ST STE 111
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5120
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Country | US
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Telephone | 913-659-5600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3000
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City | SALEM
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State | OR
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Zip | 97302-8001
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Country | US
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Telephone |
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Fax | 888-233-5233
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Authorized Official
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Title or Position | OWNER
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Name | GRANT R SMITH
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Credential | DDS
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Telephone | 913-649-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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