Provider Demographics
NPI:1275536278
Name:SMYTH, ROBERT NEIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEIL
Last Name:SMYTH
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 1:4848 ROCKWOOD PKWY NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3249
Mailing Address - Country:US
Mailing Address - Phone:202-966-4543
Mailing Address - Fax:
Practice Address - Street 1:4400 JENIFER ST NW
Practice Address - Street 2:STE 335
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2086
Practice Address - Country:US
Practice Address - Phone:202-966-3132
Practice Address - Fax:202-966-0470
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN58621223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCDEN5862OtherDENTAL LICENSE