Provider Demographics
NPI:1598793952
Name:SMITH, M. DENNIS (CRNFA)
Entity Type:Individual
Prefix:MR
First Name:M.
Middle Name:DENNIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:CRNFA
Other - Prefix:MR
Other - First Name:MARVIN
Other - Middle Name:DENNIS
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNFA
Mailing Address - Street 1:55 TWIN OAKS AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-2864
Mailing Address - Country:US
Mailing Address - Phone:541-451-6412
Mailing Address - Fax:541-451-6414
Practice Address - Street 1:55 TWIN OAKS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-2864
Practice Address - Country:US
Practice Address - Phone:541-451-6412
Practice Address - Fax:541-451-6414
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative