Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 30020484 | OH |
NPI | 1114934064 |
---|---|
Provider Name | Steven Mark Smith |
First Address | Worthington, OH 43085 |
Second Address | Worthington, OH 43085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |