Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS-027072L | PA |
NPI | 1063416675 |
---|---|
Provider Name | Dr. Paul G Smith |
First Address | Pottstown, PA 19464-3244 |
Second Address | Pottstown, PA 19464-3244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001362 | DORAL DENTAL (01) | PA |
0068555 | AETNA HMO (01) | PA |
03208601 | CAPITAL BLUE CROSS (01) | PA |
0450572000 | KEYSTONE HEALTH PLAN EAST (01) | PA |
1244005-005 | CIGNA (01) | PA |
4273120 | AETNA COMMERCIAL PLANS (01) | PA |
SM621130 | HIGHMARK (01) | PW |
T98342 | (02) | PW |