Organization
CV SMITH SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES V SMITH DDS (DENTIST)
(608) 989-2771
Entity
Organization
Contact information
Practice address
217 E 4TH STREET, BLAIR, WI 54616
(608) 989-2771
(608) 989-9626
Mailing address
PO BOX 816, BLAIR, WI 54616-0816
(608) 989-2771
(608) 989-9626
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001157-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33592400
—
WI
01
—
831108
UNITED CONCORDIA
—
Enumeration date
02/26/2007
Last updated
05/29/2013
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