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General NPI Number Information
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NPI Number | 1932499217
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Entity Type | Individual
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Provider Name | SHAUN LOCKSLEY SMITH DDS PLLC
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Gender | Male
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 8223 W ATLANTIC BLVD
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City | CORAL SPRINGS
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State | FL
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Zip | 33071
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Country | US
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Telephone | 954-368-0105
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Fax | 954-526-1747
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Provider Business Mailing Address
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Address Line | 8223 W ATLANTIC BLVD
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City | CORAL SPRINGS
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State | FL
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Zip | 33071
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Country | US
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Telephone | 954-368-0105
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Fax | 954-526-1747
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 14770
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN1000968
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401413014
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN23095
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License Number State | FL
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