Provider Demographics
NPI:1639658305
Name:SMART, RIGEL (DDS)
Entity Type:Individual
Prefix:
First Name:RIGEL
Middle Name:
Last Name:SMART
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 1:1600 COLORADO AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2718
Mailing Address - Country:US
Mailing Address - Phone:209-667-0115
Mailing Address - Fax:
Practice Address - Street 1:1600 COLORADO AVE STE 3
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2718
Practice Address - Country:US
Practice Address - Phone:209-667-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1029961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty