Provider Demographics
NPI:1114607702
Name:CHAD SMART PLLC
Entity Type:Organization
Organization Name:CHAD SMART PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-514-9525
Mailing Address - Street 1:7105 85TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-6711
Mailing Address - Country:US
Mailing Address - Phone:253-514-9525
Mailing Address - Fax:
Practice Address - Street 1:3519 56TH ST STE 140
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8593
Practice Address - Country:US
Practice Address - Phone:253-588-8581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1336329937Medicaid
WA1942248521Medicaid