Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 10084 | KY |
NPI | 1073110730 |
---|---|
Provider Name | Dr. Zachary Von Smith |
First Address | Billings, MT 59102-8626 |
Second Address | Billings, MT 59102-8626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2020 |
Last Update Date | 27/10/2020 |