Provider Demographics
NPI:1114614583
Name:SMITH, CHANEL (RDH)
Entity Type:Individual
Prefix:
First Name:CHANEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9290 HIGHLAND RIDGE HTS STE 120
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1079
Mailing Address - Country:US
Mailing Address - Phone:719-266-9000
Mailing Address - Fax:
Practice Address - Street 1:9290 HIGHLAND RIDGE HTS STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1079
Practice Address - Country:US
Practice Address - Phone:719-266-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist