Provider Demographics
NPI:1578944799
Name:SMITH, ERIK GORDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:GORDON
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 1:620 SE OAK ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4160
Mailing Address - Country:US
Mailing Address - Phone:503-693-7301
Mailing Address - Fax:
Practice Address - Street 1:620 SE OAK ST
Practice Address - Street 2:SUITE D
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4160
Practice Address - Country:US
Practice Address - Phone:503-693-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD102541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice