Individual
DANE E SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
565 5TH ST, BROOKINGS, OR 97415-9702
(541) 469-5373
(541) 412-0177
Mailing address
3500 CEDAR ST, NORTH BEND, OR 97459-1108
(541) 756-3683
(541) 756-1974
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D4773
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164848
—
OR
01
—
D4773
DENTAL LICENSE #
OR
Enumeration date
08/30/2006
Last updated
10/03/2011
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