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NPI Code Detail

MEDICARE: G. TREVOR SMITH, DDS, PC

MEDICARE: G. TREVOR SMITH, DDS, PC
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
1122300000XDentist342046UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

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

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