Provider Demographics
NPI:1821171513
Name:SMITH, DALE CAMPION (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:CAMPION
Last Name:SMITH
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 1:224 SE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7620
Mailing Address - Country:US
Mailing Address - Phone:561-737-2005
Mailing Address - Fax:561-737-5859
Practice Address - Street 1:224 SE 23RD AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7620
Practice Address - Country:US
Practice Address - Phone:561-737-2005
Practice Address - Fax:561-737-5859
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL76061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice