Provider Demographics
NPI:1477585826
Name:SMITH, PETER RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:RAYMOND
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 1:96 OLD BARNSTABLE RD
Mailing Address - Street 2:P.O. BOX 545
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3232
Mailing Address - Country:US
Mailing Address - Phone:508-477-0724
Mailing Address - Fax:508-477-4827
Practice Address - Street 1:96 OLD BARNSTABLE RD
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3232
Practice Address - Country:US
Practice Address - Phone:508-477-0724
Practice Address - Fax:508-477-4827
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice