Individual
NIKKI SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1050 BASALT CT, HEMET, CA 92543-7884
(951) 203-6618
Mailing address
1050 BASALT CT, HEMET, CA 92543-7884
(951) 203-6618
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
91379
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91379
—
CA
Enumeration date
05/12/2017
Last updated
05/12/2017
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