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General NPI Number Information
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NPI Number | 1558412379
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Entity Type | Organization
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Legal Business Name | GARY D. SMITH, D.D.S., P.C.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 118 N MAIN ST
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City | ALTUS
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State | OK
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Zip | 73521-3102
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Country | US
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Telephone | 580-482-4873
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Fax | 580-482-4895
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Provider Business Mailing Address
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Address Line | 118 N MAIN ST
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City | ALTUS
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State | OK
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Zip | 73521-3102
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Country | US
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Telephone | 580-482-4873
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Fax | 580-482-4895
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Authorized Official
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Title or Position | PRES.-OWNER
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Name | DR. GARY D. SMITH
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Credential | D.D.S.
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Telephone | 580-482-4873
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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 | 4265
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License Number State | OK
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