Provider Demographics
NPI:1235357328
Name:SMITH, RICHARD A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PONDEROSA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6583
Mailing Address - Country:US
Mailing Address - Phone:540-382-2507
Mailing Address - Fax:540-382-4065
Practice Address - Street 1:120 PONDEROSA DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6583
Practice Address - Country:US
Practice Address - Phone:540-382-2507
Practice Address - Fax:540-382-4065
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010063581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice