Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 015923 | MO |
NPI | 1083601983 |
---|---|
Provider Name | Mrs. Sarah Ann Smith |
First Address | Saint Peters, MO 63376-5350 |
Second Address | Saint Peters, MO 63376-5350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 08/07/2007 |