Provider Demographics
NPI:1134597446
Name:CHAD SMART DDS AND VINCENT O KOKICH JR DMD MSD PLLC
Entity type:Organization
Organization Name:CHAD SMART DDS AND VINCENT O KOKICH JR DMD MSD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-752-3949
Mailing Address - Street 1:2302 S UNION AVE
Mailing Address - Street 2:STE B-14
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1300
Mailing Address - Country:US
Mailing Address - Phone:253-752-3949
Mailing Address - Fax:253-752-6392
Practice Address - Street 1:2302 S UNION AVE
Practice Address - Street 2:STE B-14
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1300
Practice Address - Country:US
Practice Address - Phone:253-752-3949
Practice Address - Fax:253-752-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000090921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty