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General NPI Number Information
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NPI Number | 1386036325
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Entity Type | Organization
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Legal Business Name | CHARLES B SMURTHWAITE, D.D.S., INC.
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 6500 LONETREE BLVD STE 100
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City | ROCKLIN
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State | CA
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Zip | 95765-5874
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Country | US
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Telephone | 916-797-8511
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Fax | 916-797-8508
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Provider Business Mailing Address
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Address Line | 6500 LONETREE BLVD STE 100
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City | ROCKLIN
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State | CA
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Zip | 95765-5874
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Country | US
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Telephone | 916-797-8511
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Fax | 916-797-8508
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES B SMURTHWAITE
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Credential | DDS
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Telephone | 916-797-8511
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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 | 47801
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License Number State | CA
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