Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D4017 | AZ |
NPI | 1033482815 |
---|---|
Provider Name | Catherine Joan Smith |
First Address | Phoenix, AZ 85021-8629 |
Second Address | Phoenix, AZ 85021-8629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2012 |
Last Update Date | 09/02/2012 |