Individual
DR. MARK ELLSWORTH SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S. P.C.
Contact information
Practice address
2320 E GALA ST, 200, MERIDIAN, ID 83642-7091
(208) 846-8847
(208) 288-0786
Mailing address
2320 E. GALA ST., 200, MERIDIAN, ID 83642-4880
(208) 846-8847
(208) 288-0786
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-1463
ID
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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