Individual
KRISTEN MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
876 WELCOME WAY SE, SALEM, OR 97302
(503) 363-0031
(503) 363-0827
Mailing address
876 WELCOME WAY SE, SALEM, OR 97302
(503) 363-0031
(503) 363-0827
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10373
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1826938
UNITED CONCORDIA
WA
01
—
4512SM
REGENCE BLUE SHEILD
WA
05
—
5050125
—
WA
Enumeration date
10/18/2006
Last updated
09/15/2008
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