Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 18418 | TX |
NPI | 1013035757 |
---|---|
Provider Name | Dr. Stephanie Suzanne Smith |
First Address | Mckinney, TX 75070-5107 |
Second Address | Mckinney, TX 75070-5107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |