Provider Demographics
NPI:1417358573
Name:SMITH AND INGERSOLL, RALEIGH NC, PLLC
Entity Type:Organization
Organization Name:SMITH AND INGERSOLL, RALEIGH NC, PLLC
Other - Org Name:ROYAL OAK DENTAL GROUP AT MIDTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-847-5283
Mailing Address - Street 1:200 SAWMILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5275
Mailing Address - Country:US
Mailing Address - Phone:919-847-5283
Mailing Address - Fax:
Practice Address - Street 1:200 SAWMILL ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615
Practice Address - Country:US
Practice Address - Phone:919-847-5283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9665122300000X
NC9695122300000X
NC9696122300000X
NC5261122300000X
NC96641223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty