Provider Demographics
NPI:1154637577
Name:SMITH, ANNALISA TAYLOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNALISA
Middle Name:TAYLOR
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANNALISA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:602 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2337
Mailing Address - Country:US
Mailing Address - Phone:503-656-8250
Mailing Address - Fax:503-655-5430
Practice Address - Street 1:602 MONROE ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2337
Practice Address - Country:US
Practice Address - Phone:503-656-8250
Practice Address - Fax:503-655-5430
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601918851223G0001X
OR93601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice