Provider Demographics
NPI:1346535739
Name:SMITH, SCOTT AARON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:AARON
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:CLATSKANIE
Mailing Address - State:OR
Mailing Address - Zip Code:97016-0749
Mailing Address - Country:US
Mailing Address - Phone:503-728-2114
Mailing Address - Fax:503-728-3322
Practice Address - Street 1:400 SW BEL AIR DRIVE
Practice Address - Street 2:
Practice Address - City:CLATSKANIE
Practice Address - State:OR
Practice Address - Zip Code:97016
Practice Address - Country:US
Practice Address - Phone:503-728-2114
Practice Address - Fax:503-728-3322
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD95781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice