Provider Demographics
NPI:1649296070
Name:SMITH, NEETAL (DDS)
Entity type:Individual
Prefix:DR
First Name:NEETAL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BOARDMAN PL APT 103
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4736
Mailing Address - Country:US
Mailing Address - Phone:415-816-1493
Mailing Address - Fax:
Practice Address - Street 1:39 BOARDMAN PL
Practice Address - Street 2:#103
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4735
Practice Address - Country:US
Practice Address - Phone:415-816-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist