Provider Demographics
NPI:1275798746
Name:SMITH, STEPHEN EMERY (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EMERY
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 YELM AVE W STE 3
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8764
Mailing Address - Country:US
Mailing Address - Phone:360-458-5606
Mailing Address - Fax:360-458-1948
Practice Address - Street 1:718 YELM AVE W STE 3
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8764
Practice Address - Country:US
Practice Address - Phone:360-458-5606
Practice Address - Fax:360-458-1948
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601398301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice