Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DN16448 | FL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN16448 | FL |
NPI | 1780718411 |
---|---|
Provider Name | Dr. Damone E Smith |
First Address | Sunrise, FL 33323-0906 |
Second Address | Sunrise, FL 33323-0906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 26/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201435221 | TAX ID (01) | FL |
690057701 | (05) | FL |
690057796 | (05) | FL |