Provider Demographics
NPI:1922123009
Name:SMITH, RICK K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:K
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 1:8030 SOQUEL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2096
Mailing Address - Country:US
Mailing Address - Phone:831-462-5600
Mailing Address - Fax:831-462-0227
Practice Address - Street 1:8030 SOQUEL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2096
Practice Address - Country:US
Practice Address - Phone:831-462-5600
Practice Address - Fax:831-462-0227
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice