Provider Demographics
NPI:1841206802
Name:SMITH, STEPHANIE A (RDH)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20424 EL ROMAR DR NE
Mailing Address - Street 2:
Mailing Address - City:SCOTTS MILLS
Mailing Address - State:OR
Mailing Address - Zip Code:97375-9632
Mailing Address - Country:US
Mailing Address - Phone:503-779-4683
Mailing Address - Fax:
Practice Address - Street 1:2300 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1223
Practice Address - Country:US
Practice Address - Phone:503-370-4843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4814124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist