Healthcare Provider Details

I. General information

NPI: 1396899688
Provider Name (Legal Business Name): LANGSTON D. SMITH D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W ST NW
WASHINGTON DC
20059-0001
US

IV. Provider business mailing address

13000 PEBBLE BEACH CT
SILVER SPRING MD
20904-3580
US

V. Phone/Fax

Practice location:
  • Phone: 202-806-0341
  • Fax:
Mailing address:
  • Phone: 301-625-2616
  • Fax: 301-625-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4792
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: