Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN 5802 | FL |
NPI | 1215951132 |
---|---|
Provider Name | Dr. Donald L. Smitha |
First Address | Jacksonville, FL 32211-6102 |
Second Address | Jacksonville, FL 32211-6102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T 55259 | (02) | FL |