Provider Demographics
NPI:1174816474
Name:SMITH FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:SMITH FAMILY DENTISTRY PC
Other - Org Name:OREGON CITY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNALISA
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-656-8250
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD93601223G0001X
ORD93281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty