1063416675 NPI number — DR. PAUL G SMITH D.M.D.

Table of content: DR. PAUL G SMITH D.M.D. (NPI 1063416675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063416675 NPI number — DR. PAUL G SMITH D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
PAUL
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
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:
1063416675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1630 E HIGH ST
Provider Second Line Business Mailing Address:
BLDG 4
Provider Business Mailing Address City Name:
POTTSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19464-3244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-326-7880
Provider Business Mailing Address Fax Number:
610-326-5491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1630 E HIGH ST
Provider Second Line Business Practice Location Address:
BLDG 4
Provider Business Practice Location Address City Name:
POTTSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19464-3244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-326-7880
Provider Business Practice Location Address Fax Number:
610-326-5491
Provider Enumeration Date:
06/10/2005

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: 1223S0112X , with the licence number:  DS-027072L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001362 . This is a "DORAL DENTAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0450572000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1244005-005 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SM621130 . This is a "HIGHMARK" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".
  • Identifier: 0068555 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 03208601 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4273120 . This is a "AETNA COMMERCIAL PLANS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com