Provider Demographics
NPI:1447584545
Name:SMITH, MICHAEL ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
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 1:2050 BARB ST
Mailing Address - Street 2:SUITE #B
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98315-2098
Mailing Address - Country:US
Mailing Address - Phone:360-315-4287
Mailing Address - Fax:
Practice Address - Street 1:2050 BARB ST
Practice Address - Street 2:SUITE #B
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98315-2098
Practice Address - Country:US
Practice Address - Phone:360-315-4287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR37671223G0001X
WADE604426341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice