Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D5216 | OR |
NPI | 1043342082 |
---|---|
Provider Name | Stephen C Smith |
First Address | Aloha, OR 97007-5592 |
Second Address | Oregon City, OR 97045-4076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |