Provider Demographics
NPI:1417624420
Name:D RALEIGH SMITH DMD, PLLC
Entity Type:Organization
Organization Name:D RALEIGH SMITH DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-542-3595
Mailing Address - Street 1:1345 S PUEBLO BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1508
Mailing Address - Country:US
Mailing Address - Phone:719-542-3595
Mailing Address - Fax:
Practice Address - Street 1:1345 S PUEBLO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-1508
Practice Address - Country:US
Practice Address - Phone:719-542-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740666007OtherINDIVIDUAL NPI (TYPE 1)