Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2901016112 | MI |
NPI | 1043438286 |
---|---|
Provider Name | Dr. Aric C. Smith |
First Address | Grand Rapids, MI 49546-4353 |
Second Address | Grand Rapids, MI 49546-4353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |