Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 13411 | ND |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2230 | ND |
N | 204E00000X | Oral & Maxillofacial Surgeon | 13411 | ND |
NPI | 1386849446 |
---|---|
Provider Name | Ryan J Smart |
First Address | El Paso, TX 79925-7618 |
Second Address | Fargo, ND 58103-6172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 27/10/2021 |