Individual
GREGORY T SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4212 N. 16TH ST, PHOENIX INDIAN MEDICAL CENTER, PHOENIX, AZ 85016
(602) 263-1511
Mailing address
P.O. BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1511
(602) 263-1619
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D2500
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
418683
—
AZ
01
—
AZ0471540
BCBS
AZ
Enumeration date
10/03/2006
Last updated
07/08/2007
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