Individual
MONIQUE DASE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1717 W COWLES ST, FAIRBANKS, AK 99701-5926
(907) 459-3800
Mailing address
122 1ST AVE STE 400, FAIRBANKS, AK 99701-4871
(907) 459-3800
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
7667
AK
2084P0800X
Psychiatry Physician
MD0000048750
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1600801
—
AK
Enumeration date
04/09/2008
Last updated
05/18/2022
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