Provider Demographics
NPI:1730319963
Name:SMIDA, BRANKO (DDS)
Entity Type:Individual
Prefix:
First Name:BRANKO
Middle Name:
Last Name:SMIDA
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 1:1690 TIBURON BLVD
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2543
Mailing Address - Country:US
Mailing Address - Phone:415-328-5129
Mailing Address - Fax:415-789-0885
Practice Address - Street 1:1690 TIBURON BLVD
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-2543
Practice Address - Country:US
Practice Address - Phone:415-328-5129
Practice Address - Fax:415-789-0885
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist