Provider Demographics
NPI:1841323946
Name:SMITH, CRAIG DAVID (DDS, MS)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7530 164TH AVE NE
Mailing Address - Street 2:STE#A250
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7812
Mailing Address - Country:US
Mailing Address - Phone:425-861-9685
Mailing Address - Fax:425-882-3026
Practice Address - Street 1:7530 164TH AVE NE
Practice Address - Street 2:STE#A250
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7812
Practice Address - Country:US
Practice Address - Phone:425-861-9685
Practice Address - Fax:425-882-3026
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000056231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics