Provider Demographics
NPI:1497102149
Name:SMART, DALAINA KRISTIN
Entity Type:Individual
Prefix:
First Name:DALAINA
Middle Name:KRISTIN
Last Name:SMART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71536 S 4737 RD
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74965-7012
Mailing Address - Country:US
Mailing Address - Phone:918-723-3181
Mailing Address - Fax:
Practice Address - Street 1:500 W. CHINCAPIN ST.
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:OK
Practice Address - Zip Code:74965
Practice Address - Country:US
Practice Address - Phone:918-723-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other