# KEVIN J SMITH DDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prairie Dental Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689888158
- **Authorized official:** MRS. TIFFANY SMITH (OFFICE MANAGER)
- **Authorized official phone:** (360) 944-9800

## Contact information

- **Practice address:** 10001 NE 117TH AVE, VANCOUVER, WA 98662-1504
- **Practice address phone:** (360) 944-9800
- **Mailing address:** 10001 NE 117TH AVE, VANCOUVER, WA 98662-1504
- **Mailing address phone:** (360) 944-9800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE60171756 | WA | Yes |
| 1223G0001X | General Practice Dentistry | DE00007532 | WA | — |
| 1223G0001X | General Practice Dentistry | DE00010195 | WA | — |

## Other

- **Enumeration date:** 05/10/2007
- **Last updated:** 04/18/2016