Provider Demographics
NPI:1003847344
Name:SMITH, CHRISTINE A (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3657 PERRYSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15214-2229
Mailing Address - Country:US
Mailing Address - Phone:412-512-9649
Mailing Address - Fax:412-885-3785
Practice Address - Street 1:306 TOWNE SQUARE WAY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-3255
Practice Address - Country:US
Practice Address - Phone:412-885-3250
Practice Address - Fax:412-885-3785
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0359951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009544060002Medicaid