Provider Demographics
NPI:1205812120
Name:SMITH, TIMOTHY NEIL (DMD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:NEIL
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:NEIL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:12 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3940
Mailing Address - Country:US
Mailing Address - Phone:617-323-5700
Mailing Address - Fax:617-325-3166
Practice Address - Street 1:12 SPRING ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02132-3940
Practice Address - Country:US
Practice Address - Phone:617-323-5700
Practice Address - Fax:617-325-3166
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice