Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 12446 | MO |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5617 | KS |
NPI | 1063449544 |
---|---|
Provider Name | Dr. Max D Smith Jr. |
First Address | Overland Park, KS 66214 |
Second Address | Overland Park, KS 66214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T81810 | (02) |