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General NPI Number Information
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NPI Number | 1760627301
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Entity Type | Organization
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Legal Business Name | JEREMY D. SMITH, DDS, PA
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 604 S 52ND ST
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City | ROGERS
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State | AR
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Zip | 72758-8601
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Country | US
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Telephone | 479-636-2990
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Fax | 479-636-2999
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Provider Business Mailing Address
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Address Line | 604 S 52ND ST
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City | ROGERS
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State | AR
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Zip | 72758-8601
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Country | US
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Telephone | 479-636-2990
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Fax | 479-636-2999
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Authorized Official
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Title or Position | TREATMENT COORDINATOR
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Name | STEPHANIE TACKEL
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Credential |
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Telephone | 479-636-2990
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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 | 3384
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License Number State | AR
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