Provider Demographics
NPI:1740666007
Name:SMITH, DAMIAN RALEIGH (DMD)
Entity type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:RALEIGH
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 S PUEBLO BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1508
Mailing Address - Country:US
Mailing Address - Phone:719-542-3595
Mailing Address - Fax:
Practice Address - Street 1:1345 S PUEBLO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-1508
Practice Address - Country:US
Practice Address - Phone:719-722-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-09
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002046971223G0001X
NMDD43761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice