Basic Information
| Provider Information | |||||||||
| NPI: | 1386849446 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMART | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10175 GATEWAY BLVD W STE 304 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799257618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155046880 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2585 23RD AVE S UNIT A | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581036172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014784404 | ||||||||
| FaxNumber: | 7014784407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 13411 | ND | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | 2230 | ND | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 204E00000X | 13411 | ND | N | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery |
No ID Information.