=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922791060
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN K SMITH DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2023
-----------------------------------------------------
Last Update Date | 06/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2797 N HIGHWAY 89 STE 201
-----------------------------------------------------
City | PLEASANT VIEW
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84404-1231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-324-3557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 442 E 1625 N
-----------------------------------------------------
City | NORTH OGDEN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84404-3402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-628-8737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 13430091-9923
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------