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General NPI Number Information
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NPI Number | 1740758028
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Entity Type | Organization
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Legal Business Name | SILVER CITY ORTHODONTICS LLC
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 1340 E 32ND ST
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City | SILVER CITY
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State | NM
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Zip | 88061-7252
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Country | US
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Telephone | 928-428-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 S 20TH AVE
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City | SAFFORD
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State | AZ
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Zip | 85546-4053
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Country | US
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Telephone | 928-428-5555
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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. BRADLEY R. SMITH
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Credential | DMD, DHSC
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Telephone | 480-612-7115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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