Provider Demographics
NPI:1851693337
Name:SMITH FAMILY DENTAL
Entity Type:Organization
Organization Name:SMITH FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST- OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-466-2373
Mailing Address - Street 1:315 W HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2576
Mailing Address - Country:US
Mailing Address - Phone:509-466-2373
Mailing Address - Fax:509-466-4707
Practice Address - Street 1:315 W HASTINGS RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2576
Practice Address - Country:US
Practice Address - Phone:509-466-2373
Practice Address - Fax:509-466-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID04171261QD0000X
WADE60311143261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental