Provider Demographics
NPI:1114969599
Name:SMOVIR, WENDY L KINCAID (DMD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:L KINCAID
Last Name:SMOVIR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:KINCAID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4855 SW WESTERN AVE.
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3499
Mailing Address - Country:US
Mailing Address - Phone:503-626-4148
Mailing Address - Fax:
Practice Address - Street 1:4855 SW WESTERN AVE.
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3499
Practice Address - Country:US
Practice Address - Phone:503-626-4148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice