Provider Demographics
NPI:1639346778
Name:SMITH, COLIN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16699 BOONES FERRY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4368
Mailing Address - Country:US
Mailing Address - Phone:503-635-3653
Mailing Address - Fax:503-635-3654
Practice Address - Street 1:16699 BOONES FERRY RD
Practice Address - Street 2:STE 200
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4368
Practice Address - Country:US
Practice Address - Phone:503-635-3653
Practice Address - Fax:503-635-3654
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice