Provider Demographics
NPI:1689777062
Name:SMITH, CRAIG ARDIE (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ARDIE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 HANOVER PARKWAY STE A
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2006
Mailing Address - Country:US
Mailing Address - Phone:301-446-1784
Mailing Address - Fax:301-446-1787
Practice Address - Street 1:7201 HANOVER PARKWAY STE A
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2006
Practice Address - Country:US
Practice Address - Phone:301-446-1784
Practice Address - Fax:301-446-1787
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist