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NPI Code Detail

MEDICARE: VAE DON SMITH DMD

MEDICARE: VAE DON SMITH DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry0933NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10933OTHERNVSTATE LICENSE

General Provider Information

NPI Number : 1114991817
Entity Type Code : Individual
Provider Name (Legal Business Name) : VAE DON SMITH DMD
Provider Business Mailing Address
First Line : 4301 S NELLIS BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-3120
Country : US
Telephone Number : 702-456-8118
Fax Number : 702-456-4010
Provider Business Practice Location Address
First Line : 4301 S NELLIS BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-3120
Country : US
Telephone Number : 702-456-8118
Fax Number : 702-456-4010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 07/08/2007

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Directions to “ VAE DON SMITH DMD” Practice Location

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