Provider Demographics
NPI:1932892338
Name:SMITH-GASKINS, DALLAS (SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:DALLAS
Middle Name:
Last Name:SMITH-GASKINS
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:DALLAS
Other - Middle Name:
Other - Last Name:SMITH-GASKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SPECIALIST
Mailing Address - Street 1:8765 BRANCH AVE STE 23
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2630
Mailing Address - Country:US
Mailing Address - Phone:571-268-2164
Mailing Address - Fax:
Practice Address - Street 1:8765 BRANCH AVE STE 23
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2630
Practice Address - Country:US
Practice Address - Phone:571-268-2164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1201122443174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist