Individual
RUSSELL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
6415 BUSINESS PARK LOOP RD STE J, PARK CITY, UT 84098-6218
(801) 693-8147
Mailing address
114 W 550 N, CENTERVILLE, UT 84014-1825
(801) 693-8147
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5587305-9921
UT
Other
Enumeration date
07/14/2008
Last updated
08/01/2012
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