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General NPI Number Information
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NPI Number | 1336694231
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Entity Type | Organization
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Legal Business Name | YELM DENTAL
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Dates
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Enumeration Date | 08/20/2016
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Last Update Date | 08/20/2016
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Provider Practice Location Address
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Address Line | 718 W YELM AVE # 3
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City | YELM
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State | WA
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Zip | 98597-8764
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Country | US
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Telephone | 360-458-5606
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Fax |
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Provider Business Mailing Address
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Address Line | 718 W YELM AVE # 3
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City | YELM
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State | WA
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Zip | 98597-8764
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Country | US
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Telephone | 360-458-5606
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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. STEPHEN E SMITH
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Credential | DMD
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Telephone | 360-458-5606
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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 | DE60674424
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License Number State | WA
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