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General NPI Number Information
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NPI Number | 1275926362
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Entity Type | Organization
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Legal Business Name | SMITHDMD
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 1133 N MAIN ST LOWER MEZZANINE
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City | LAYTON
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State | UT
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Zip | 84041-4800
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Country | US
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Telephone | 801-546-0931
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Fax |
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Provider Business Mailing Address
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Address Line | 1133 N MAIN ST LOWER MEZZANINE
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City | LAYTON
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State | UT
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Zip | 84041-4800
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Country | US
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Telephone | 801-546-0931
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HANS DALAN SMITH
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Credential | DMD
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Telephone | 435-849-1914
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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 | 4909855-9922
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License Number State | UT
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