Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 25534 | TX |
NPI | 1528153640 |
---|---|
Provider Name | Kevin G Smith |
First Address | San Antonio, TX 78256-1635 |
Second Address | San Antonio, TX 78256-1635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 12/02/2016 |