Healthcare Provider Details

I. General information

NPI: 1326037797
Provider Name (Legal Business Name): JAY CHRISTOPHER SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BROOKLEY AVE STE 214
BOLLING AFB DC
20332-0001
US

IV. Provider business mailing address

7801 MIDDAY LN
ALEXANDRIA VA
22306-2722
US

V. Phone/Fax

Practice location:
  • Phone: 202-404-3575
  • Fax:
Mailing address:
  • Phone: 703-768-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS029715L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: