Provider Demographics
NPI:1699721688
Name:SMITH DENTAL CORPORATION
Entity type:Organization
Organization Name:SMITH DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-567-9707
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:916-567-9707
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:916-567-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty