Provider Demographics
NPI:1508995721
Name:SMITH, HUBERT RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUBERT
Middle Name:RAY
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 1:3210 CUNNINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2211
Mailing Address - Country:US
Mailing Address - Phone:703-780-7900
Mailing Address - Fax:
Practice Address - Street 1:3210 CUNNINGHAM DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-2211
Practice Address - Country:US
Practice Address - Phone:703-780-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010034271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice