Provider Demographics
NPI:1720282791
Name:SMITH, SHIRLEY M (BS, RDH, HAP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS, RDH, HAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7233
Mailing Address - Street 2:
Mailing Address - City:SPRECKELS
Mailing Address - State:CA
Mailing Address - Zip Code:93962-7233
Mailing Address - Country:US
Mailing Address - Phone:831-594-1598
Mailing Address - Fax:
Practice Address - Street 1:28779 UNDERWOOD RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93908-8923
Practice Address - Country:US
Practice Address - Phone:831-594-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA177124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist