Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 00202057 | CO |
NPI | 1588951446 |
---|---|
Provider Name | Dr. Kristopher R. Smith |
First Address | Greenwood Village, CO 80111-2990 |
Second Address | Greenwood Village, CO 80111-2990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2011 |
Last Update Date | 13/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41489268 | (05) | CO |