1780718411 NPI number — DR. DAMONE E SMITH DDS

Table of content: DR. DAMONE E SMITH DDS (NPI 1780718411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780718411 NPI number — DR. DAMONE E SMITH DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
DAMONE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1780718411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12651 W SUNRISE BLVD
Provider Second Line Business Mailing Address:
#304
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-0906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-845-0098
Provider Business Mailing Address Fax Number:
954-845-0280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12651 W SUNRISE BLVD
Provider Second Line Business Practice Location Address:
#304
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33323-0906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-845-0098
Provider Business Practice Location Address Fax Number:
954-845-0280
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0106X , with the licence number:  DN16448 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , with the licence number: DN16448 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 690057796 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201435221 . This is a "TAX ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 690057701 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112131100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com