Active NPI
Dena Lou Smith, M.D. FACS
- Surgery Physician
- Nipomo, CA
National Provider Identifier
1134500770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- A-20644
- Practice address
- 615 Black Ridge Lane
Nipomo, CA 93444 - Phone
- (805) 929-5220
- Fax
- (805) 929-5220
- NPI assigned
- Jun 9, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | A-20644 | CA | Primary |
Addresses
Primary practice location
615 Black Ridge Lane
Nipomo, CA 93444
Mailing address
615 Black Ridge Lane
Nipomo, CA 93444
Phone (805) 929-5220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A-20644 | CA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1433808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433808000000",
"number": "1134500770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 BLACK RIDGE LANE",
"city": "NIPOMO",
"state": "CA",
"postal_code": "93444",
"telephone_number": "805-929-5220",
"fax_number": "805-929-5220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 BLACK RIDGE LANE",
"city": "NIPOMO",
"state": "CA",
"postal_code": "93444",
"telephone_number": "805-929-5220",
"fax_number": "805-929-5220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "DENA",
"middle_name": "LOU",
"name_prefix": "Ms.",
"credential": "M.D. FACS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-09",
"last_updated": "2015-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "A-20644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nipomo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.