Provider Demographics
NPI:1871647164
Name:SMILEY, CHRISTOPHER BRUCE (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRUCE
Last Name:SMILEY
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 1:9401 COURTHOUSE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6690
Mailing Address - Country:US
Mailing Address - Phone:804-748-9211
Mailing Address - Fax:804-768-4708
Practice Address - Street 1:9401 COURTHOUSE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6690
Practice Address - Country:US
Practice Address - Phone:804-748-9211
Practice Address - Fax:804-768-4708
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010078361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA112347OtherBLUE CROSS BLUE SHEILD
VA903135OtherUNITED CONCORDIA