Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5960 | NC |
NPI | 1235235169 |
---|---|
Provider Name | Terrance Lee Smith |
First Address | Fayetteville, NC 28304-3688 |
Second Address | Fayetteville, NC 28304-3688 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8997905 | (05) | NC |
U38330 | (02) | NC |