Provider Demographics
NPI:1245469881
Name:SMOLENSKI, DUSTIN MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:MICHAEL
Last Name:SMOLENSKI
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 1:5633 QUERCUS LN
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-1837
Mailing Address - Country:US
Mailing Address - Phone:563-359-9144
Mailing Address - Fax:563-359-9146
Practice Address - Street 1:5105 JERSEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3134
Practice Address - Country:US
Practice Address - Phone:563-359-9144
Practice Address - Fax:563-359-9146
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA086461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice