Provider Demographics
NPI:1053068692
Name:NICHOLAS SMILEY DDS MD PLLC
Entity Type:Organization
Organization Name:NICHOLAS SMILEY DDS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-667-7669
Mailing Address - Street 1:1363 COLUMBIA PARK TRL STE 103
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4770
Mailing Address - Country:US
Mailing Address - Phone:877-667-7669
Mailing Address - Fax:
Practice Address - Street 1:1363 COLUMBIA PARK TRL STE 103
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4770
Practice Address - Country:US
Practice Address - Phone:877-667-7669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty