Provider Demographics
NPI:1356372957
Name:SMITH, JONATHAN JAY (DDS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JAY
Last Name:SMITH
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 1:315 W HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2576
Mailing Address - Country:US
Mailing Address - Phone:509-466-2373
Mailing Address - Fax:509-466-4707
Practice Address - Street 1:315 W HASTINGS RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2576
Practice Address - Country:US
Practice Address - Phone:509-466-2373
Practice Address - Fax:509-466-4707
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4171122300000X
WADE603111431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist