Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6428 | CO |
NPI | 1023115490 |
---|---|
Provider Name | Dr. Scott D. Smith |
First Address | Centennial, CO 80112-7200 |
Second Address | Centennial, CO 80112-7200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |