Jonathan B Smith, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

202990 Issued in CO

Practice address

3093 Broadway St
Boulder, CO 80304-3151

Phone

(303) 442-4437

Fax

(303) 442-4921

NPI assigned

Jul 11, 2013

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

• Boulder Canyon Dental PLLC

  • Dentist
  • Boulder, CO
  • NPI 1588109862
  Authorized official Same address or phone

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

{
    "created_epoch": "1373500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482192000000",
    "number": "1659712206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3093 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043151",
            "telephone_number": "303-442-4437",
            "fax_number": "303-442-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3093 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043151",
            "telephone_number": "303-442-4437",
            "fax_number": "303-442-4921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JONATHAN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-11",
        "last_updated": "2016-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "202990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Forrest J Smith
• Holly Angela Smith, M.A
• Hunter Russell Smith, M.D.
• Jeffrey Teddy Smith, O.D.
• Jessica Sloan Smith
• Joshua James Smith
• Karissa Marlene Smith, L.A.C. , RN
• Kathleen Cornelius Smith, LPC
• Ki Nina Elizabeth Smith
• Laura Lee Smith, M.P.T.

• Dentist in Boulder, CO
• Providers in Boulder, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.