Organization
KEVIN J SMITH DDS PLLC
Active
Other names
Prairie Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIFFANY SMITH (OFFICE MANAGER)
(360) 944-9800
Entity
Organization
Contact information
Practice address
10001 NE 117TH AVE, VANCOUVER, WA 98662-1504
(360) 944-9800
Mailing address
10001 NE 117TH AVE, VANCOUVER, WA 98662-1504
(360) 944-9800
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE60171756
WA
1223G0001X
General Practice Dentistry
DE00007532
WA
1223G0001X
General Practice Dentistry
DE00010195
WA
Other
Enumeration date
05/10/2007
Last updated
04/18/2016
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