Provider Demographics
NPI:1558673806
Name:SMITH, CRAIG LOT (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:LOT
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 1:2501 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2540
Mailing Address - Country:US
Mailing Address - Phone:206-940-4456
Mailing Address - Fax:
Practice Address - Street 1:2501 N PEARL ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2540
Practice Address - Country:US
Practice Address - Phone:206-940-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADR601717011223G0001X
WADE601746591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice