Provider Demographics
NPI:1023329778
Name:SMITH, NATHAN MERRILL (DMD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:MERRILL
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140B PURCELLVILLE GATEWAY DR # 543
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3485
Mailing Address - Country:US
Mailing Address - Phone:412-389-9233
Mailing Address - Fax:
Practice Address - Street 1:140B PURCELLVILLE GATEWAY DR # 543
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3485
Practice Address - Country:US
Practice Address - Phone:412-389-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023261122300000X
VA04014162421223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No122300000XDental ProvidersDentist