Provider Demographics
NPI:1659630663
Name:SMITH, MARITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARITA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARITA
Other - Middle Name:
Other - Last Name:IZMAILOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5C MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970
Mailing Address - Country:US
Mailing Address - Phone:845-364-9400
Mailing Address - Fax:845-364-0284
Practice Address - Street 1:5C MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-364-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0562241223P0221X
NJ22DI024866001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry