Provider Demographics
NPI:1881777175
Name:SMITH, DALE ALAN (DALE SMITH RNFA)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DALE SMITH RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 SEBAGO LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2328
Mailing Address - Country:US
Mailing Address - Phone:207-751-8144
Mailing Address - Fax:
Practice Address - Street 1:192 SEBAGO LAKE RD
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-2328
Practice Address - Country:US
Practice Address - Phone:207-751-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER024945163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant