Provider Demographics
NPI:1417299165
Name:SMITH, RICHARD N (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:N
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 1:415 MIDDLEBURY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2537
Mailing Address - Country:US
Mailing Address - Phone:203-758-2116
Mailing Address - Fax:203-758-9522
Practice Address - Street 1:415 MIDDLEBURY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2537
Practice Address - Country:US
Practice Address - Phone:203-758-2116
Practice Address - Fax:203-758-9522
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT71141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice