Provider Demographics
NPI:1558382291
Name:SMITH, DARRYL ROGER (DDS)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:ROGER
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 1:26 PURITAN RD
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2726
Mailing Address - Country:US
Mailing Address - Phone:781-592-1620
Mailing Address - Fax:781-592-1625
Practice Address - Street 1:26 PURITAN RD
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2726
Practice Address - Country:US
Practice Address - Phone:781-592-1620
Practice Address - Fax:781-592-1625
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice