Provider Demographics
NPI:1316986953
Name:SMITH, PAUL BRADFORD (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRADFORD
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 HOWE AVE
Mailing Address - Street 2:#200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4616
Mailing Address - Country:US
Mailing Address - Phone:916-567-9707
Mailing Address - Fax:916-567-9970
Practice Address - Street 1:730 HOWE AVE
Practice Address - Street 2:#200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4616
Practice Address - Country:US
Practice Address - Phone:916-567-9707
Practice Address - Fax:916-567-9970
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice