Provider Demographics
NPI:1609011311
Name:SCOTT R. SMITH DDS.,PC
Entity Type:Organization
Organization Name:SCOTT R. SMITH DDS.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-265-5577
Mailing Address - Street 1:770 RIVERSIDE AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1476
Mailing Address - Country:US
Mailing Address - Phone:517-265-5577
Mailing Address - Fax:517-265-8068
Practice Address - Street 1:770 RIVERSIDE AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1476
Practice Address - Country:US
Practice Address - Phone:517-265-5577
Practice Address - Fax:517-265-8068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
125561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty