Individual
TIMOTHY ALAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CD
Contact information
Practice address
38565 PROCTOR BLVD, SANDY, OR 97055-0744
(503) 668-8914
Mailing address
PO BOX 744, SANDY, OR 97055-0744
(503) 668-8914
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-DO-671615
OR
Other
Enumeration date
05/29/2008
Last updated
05/29/2008
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