1245606177 NPI number — EAST ALLEN DENE SMITH DDS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245606177 NPI number — EAST ALLEN DENE SMITH DDS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST ALLEN DENE SMITH DDS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245606177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11075 S STATE ST STE 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84070-5169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-891-5860
Provider Business Mailing Address Fax Number:
513-891-5869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 MONTGOMERY RD
Provider Second Line Business Practice Location Address:
SUITE 1 A
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45242-7789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-891-5860
Provider Business Practice Location Address Fax Number:
513-891-5869
Provider Enumeration Date:
08/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
DENE
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
513-891-5860

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  30023313 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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