Provider Demographics
NPI:1851313936
Name:SMITH, EUNICE (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 KINKAID RD
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21402-1006
Mailing Address - Country:US
Mailing Address - Phone:410-293-3902
Mailing Address - Fax:
Practice Address - Street 1:250 WOOD ROAD
Practice Address - Street 2:NAVAL HEALTH CLINIC
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402
Practice Address - Country:US
Practice Address - Phone:410-293-4378
Practice Address - Fax:410-293-1190
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1322124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN