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General NPI Number Information
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NPI Number | 1760753099
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Entity Type | Organization
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Legal Business Name | G. TREVOR SMITH, DDS, PC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 60 E STATE RD
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2637
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Country | US
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Telephone | 801-785-2574
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Fax | 801-785-2697
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Provider Business Mailing Address
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Address Line | 60 E STATE RD
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2637
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Country | US
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Telephone | 801-785-2574
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Fax | 801-785-2697
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Authorized Official
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Title or Position | DENTIST
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Name | GAVIN TREVOR SMITH
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Credential | DDS
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Telephone | 801-785-2574
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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 | 342046
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License Number State | UT
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