Active NPI
Gregory Grant Smith, D.D.S.
- General Practice Dentistry
- Council, ID
National Provider Identifier
1619973401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D-5262
- Practice address
- 205 N Berkley St
Council, ID 83612-5015 - Phone
- (208) 253-4242
- NPI assigned
- Jun 27, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D-5262 | ID | Primary |
| General Practice Dentistry | 1223G0001X | 45619 | CA |
Addresses
Primary practice location
205 N Berkley St
Council, ID 83612-5015
Mailing address
PO Box 1268
McCall, ID 83638-1268
Phone (714) 552-1562
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45619 | CA | MD | General Practice Dentistry |
| D-5262 | ID | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632355200000",
"number": "1619973401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1268",
"city": "MCCALL",
"state": "ID",
"postal_code": "836381268",
"telephone_number": "714-552-1562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 N BERKLEY ST",
"city": "COUNCIL",
"state": "ID",
"postal_code": "836125015",
"telephone_number": "208-253-4242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "GREGORY",
"middle_name": "GRANT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-27",
"last_updated": "2021-09-23",
"certification_date": "2021-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ID",
"license": "D-5262",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "45619",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Council, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.