Provider Demographics
NPI:1396755005
Name:SMYTH, PATRICIA (DDS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SMYTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 S ADAMS AVE. #1
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405
Mailing Address - Country:US
Mailing Address - Phone:801-476-1234
Mailing Address - Fax:801-479-4926
Practice Address - Street 1:5300 S ADAMS AVE.
Practice Address - Street 2:#1
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-476-1234
Practice Address - Fax:801-479-4926
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2674501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice