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NPI Code Detail

MEDICARE: THEODORE ROBERT SMALL DDS

MEDICARE: THEODORE ROBERT SMALL DDS
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
1122300000XDentist140487-9926UT

General Provider Information

NPI Number : 1497112338
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEODORE ROBERT SMALL DDS
Provider Business Mailing Address
First Line : 30 W MEDICAL DR
Second Line :
City : MONUMENT VALLEY
State : UT
Zip : 84536-7705
Country : US
Telephone Number : 510-239-3172
Fax Number :
Provider Business Practice Location Address
First Line : 30 W MEDICAL DR
Second Line :
City : MONUMENT VALLEY
State : UT
Zip : 84536-7705
Country : US
Telephone Number : 435-727-3004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2016
Last Update Date : 02/03/2026

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