Individual
JONATHAN DEAN SMART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2342 NW PROFESSIONAL DR., CORVALLIS, OR 97330
(541) 757-7708
(541) 738-7192
Mailing address
2342 NW PROFESSIONAL DR., CORVALLIS, OR 97330
(541) 757-7708
(541) 738-7192
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5765733-9922
UT
1223G0001X
General Practice Dentistry
D8256
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1702399
UNITED CONCORDIA
UT
01
—
5765733
CIGNA
UT
01
—
57657339900001
BC/BS
UT
01
—
77777
DELTA
UT
01
—
84083
PEHP
UT
01
—
885140
DMBA
UT
Enumeration date
08/12/2006
Last updated
09/07/2012
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