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General NPI Number Information
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NPI Number | 1598331084
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Entity Type | Individual
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Provider Name | SHAYNE ALEXANDER SMITH DDS
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Gender | Male
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 3102 E ELK LN
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City | FREMONT
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State | NE
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Zip | 68025-8636
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Country | US
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Telephone | 402-512-4028
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Fax |
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Provider Business Mailing Address
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Address Line | 12141 BURDETTE CIR
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City | OMAHA
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State | NE
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Zip | 68164-3565
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Country | US
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Telephone | 360-349-1662
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7711
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License Number State | NE
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