Provider Demographics
NPI:1194832931
Name:HIEBERT, SMITH DENTAL GROUP, PC
Entity Type:Organization
Organization Name:HIEBERT, SMITH DENTAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-397-6144
Mailing Address - Street 1:1550 SAINT HELENS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1728
Mailing Address - Country:US
Mailing Address - Phone:503-397-6144
Mailing Address - Fax:503-397-4433
Practice Address - Street 1:1550 SAINT HELENS ST
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1728
Practice Address - Country:US
Practice Address - Phone:503-397-6144
Practice Address - Fax:503-397-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1187748-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty