Provider Demographics
NPI:1568803393
Name:TRACY L SMITH, DDS
Entity Type:Organization
Organization Name:TRACY L SMITH, DDS
Other - Org Name:BLUE HILL PENINSULA DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-374-5538
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-0922
Mailing Address - Country:US
Mailing Address - Phone:207-374-5538
Mailing Address - Fax:207-374-2929
Practice Address - Street 1:120 SOUTH ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-6120
Practice Address - Country:US
Practice Address - Phone:207-374-5538
Practice Address - Fax:207-374-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty