Mark Ellsworth Smith, D.D.S. P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-1463 Issued in ID

Practice address

2320 E Gala St
200
Meridian, ID 83642-7091

Phone

(208) 846-8847

Fax

(208) 288-0786

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366520827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 E. GALA ST.",
            "address_2": "200",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836424880",
            "telephone_number": "208-846-8847",
            "fax_number": "208-288-0786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 E GALA ST",
            "address_2": "200",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427091",
            "telephone_number": "208-846-8847",
            "fax_number": "208-288-0786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARK",
        "middle_name": "ELLSWORTH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.  P.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-1463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer L Smith, LCPC
• Karisa M Smith, MA, LPC
• Kimberly Smith
• Kyle Thomas Smith, PHARMD
• Mark Smith, PHARMD
• Mary Lynn Smith, RN
• Michael R Smith, NP-C
• Rachael Eve Smith, PNP-PC
• Randall B Smith, D.M.D.
• Rhonda M Smith, MS CCC-SLP

• General Practice Dentistry in Meridian, ID
• Providers in Meridian, ID by specialty
• General Practice Dentistry in Idaho

• 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.