Gary Alfred Smith, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6699 Issued in IA

Practice address

2612 W Broadway
Council Bluffs, IA 51501-3510

Phone

(712) 323-3615

Fax

(712) 325-6155

NPI assigned

Jun 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Broadway Family and Cosmetic Dentistry, P.C.

  • General Practice Dentistry
  • Council Bluffs, IA
  • NPI 1053442244
  NPD (past) Authorized official
• Broadway Family and Cosmetic Dentistry, Partnership

  • General Practice Dentistry
  • Council Bluffs, IA
  • NPI 1063715969
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063441384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2612 W BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013510",
            "telephone_number": "712-323-3615",
            "fax_number": "712-325-6155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2612 W BROADWAY",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515013510",
            "telephone_number": "712-323-3615",
            "fax_number": "712-325-6155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GARY",
        "middle_name": "ALFRED",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "6699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "039537",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL-IA",
            "identifier": "18575",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD-NE",
            "identifier": "5334",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK",
            "identifier": "18575",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Simpson
• Harmit Singh, MD
• Maryann Slack
• Terrence Thomas Slattery, M.D.
• Carl Dean Smith, PHARMD
• Kelsi Smith
• Krista Smith, A.R.N.P.
• Paul Smith
• Scott P Smith, M.D.
• Stephen C Smith, M.D.

• General Practice Dentistry in Council Bluffs, IA
• Providers in Council Bluffs, IA by specialty
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.