Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | D5788 | AZ |
NPI | 1104945682 |
---|---|
Provider Name | Dr. Christopher D Smith |
First Address | Prescott, AZ 86305 |
Second Address | Prescott, AZ 86305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1516207 | UNITED CONCORDIA INS (01) |