Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 7366911 | UT |
NPI | 1073736070 |
---|---|
Provider Name | Dr. Peter N Smith |
First Address | Orem, UT 84097 |
Second Address | Orem, UT 84097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 25/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200840420 | (05) | IN |