Individual
DR. CHARLES WILLIAM SMITH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5039 HWY 52N W. FRONTAGE, ROCHESTER, MN 55901
(507) 282-7905
(507) 286-9382
Mailing address
5039 HIGHWAY 52 NORTH FRONTAGE ROAD, ROCHESTER, MN 55901
(507) 282-7905
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9387
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5011757
MD TAX ID
MN
01
—
555133
MN DEPT OF HEALTH
MN
Enumeration date
08/25/2005
Last updated
12/30/2015
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