Provider Demographics
NPI:1134357411
Name:SMITH, AMY BETH (DMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:BETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 SEATTLE SLEW RUN
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-248-2973
Mailing Address - Fax:509-469-8556
Practice Address - Street 1:925 SEATTLE SLEW RUN
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908
Practice Address - Country:US
Practice Address - Phone:509-248-2973
Practice Address - Fax:509-469-2556
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60086466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist