Individual
SHANE B SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1501 S 40TH AVE, YAKIMA, WA 98908-3963
(509) 577-8277
(509) 573-4858
Mailing address
1501 S 40TH AVE, YAKIMA, WA 98908-3963
(509) 577-8277
(509) 573-4858
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8412
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0157861
LABOR & INDUSTRIES
WA
01
—
1361168
UNITED CONCORDIA
WA
05
—
5031547
—
WA
01
—
8412
STATE LICENSE
WA
01
—
8931059
CRIME VICTIMS
WA
01
—
92560941
TPIN
WA
Enumeration date
10/10/2006
Last updated
03/07/2023
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