Healthcare Provider Details

I. General information

NPI: 1023170263
Provider Name (Legal Business Name): ALAN T SMITH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BROOKLEY AVE
BOLLING AFB DC
20332
US

IV. Provider business mailing address

13959 S SPRINGS DR
CLIFTON VA
20124-2453
US

V. Phone/Fax

Practice location:
  • Phone: 202-404-3603
  • Fax: 202-404-1256
Mailing address:
  • Phone: 703-815-4242
  • Fax: 703-815-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: