Provider Demographics
NPI:1790355121
Name:SMITH, NICHOLAS HAMPTON (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:HAMPTON
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 1:4751 W JUNCO ST
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-5813
Mailing Address - Country:US
Mailing Address - Phone:208-251-8666
Mailing Address - Fax:
Practice Address - Street 1:417 E BROADWAY AVE STE 103
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-3081
Practice Address - Country:US
Practice Address - Phone:509-765-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0110811223G0001X
WADE615188601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice