Provider Demographics
NPI:1518982040
Name:SMITH, STEPHEN C (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
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:P.O. BOX 221993
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93922
Mailing Address - Country:US
Mailing Address - Phone:831-626-5900
Mailing Address - Fax:831-626-5906
Practice Address - Street 1:26485 CARMEL RANCHO BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923
Practice Address - Country:US
Practice Address - Phone:831-626-5900
Practice Address - Fax:831-626-5906
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics