Healthcare Provider Details

I. General information

NPI: 1851490429
Provider Name (Legal Business Name): DOUGLAS B. SMAIL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FEDERAL ST SUITE 202
TROY NY
12180-2832
US

IV. Provider business mailing address

500 FEDERAL ST
TROY NY
12180-2832
US

V. Phone/Fax

Practice location:
  • Phone: 518-272-3221
  • Fax:
Mailing address:
  • Phone: 518-272-3221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number44679
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: