Provider Demographics
NPI:1952762130
Name:SMILEY, NICHOLAS (DDS, MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:SMILEY
Suffix:
Gender:
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 COLUMBIA PARK TRL STE 103
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4770
Mailing Address - Country:US
Mailing Address - Phone:509-802-6026
Mailing Address - Fax:
Practice Address - Street 1:1363 COLUMBIA PARK TRL STE 103
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4770
Practice Address - Country:US
Practice Address - Phone:877-667-7669
Practice Address - Fax:888-920-7457
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE607418771223S0112X
WADR606523611223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program