Provider Demographics
NPI:1538212048
Name:MATTHEW T SMITH DDS PC
Entity type:Organization
Organization Name:MATTHEW T SMITH DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-203-3255
Mailing Address - Street 1:9301 E SHEA BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6733
Mailing Address - Country:US
Mailing Address - Phone:480-767-8804
Mailing Address - Fax:480-767-1353
Practice Address - Street 1:9301 E SHEA BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6733
Practice Address - Country:US
Practice Address - Phone:480-767-8804
Practice Address - Fax:480-767-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD4932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty