Provider Demographics
NPI:1548810401
Name:SMART & GIBBS
Entity type:Organization
Organization Name:SMART & GIBBS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-273-3376
Mailing Address - Street 1:3200 W CLUBHOUSE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4325
Mailing Address - Country:US
Mailing Address - Phone:385-273-3376
Mailing Address - Fax:
Practice Address - Street 1:3200 W CLUBHOUSE DR STE 100
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4325
Practice Address - Country:US
Practice Address - Phone:385-273-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty