Healthcare Provider Details

I. General information

NPI: 1962727693
Provider Name (Legal Business Name): CORY M. SMITH, DMD, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N 2ND AVE
STAYTON OR
97383-1715
US

IV. Provider business mailing address

505 N 2ND AVE
STAYTON OR
97383-1715
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-3366
  • Fax: 503-769-5501
Mailing address:
  • Phone: 503-769-3366
  • Fax: 503-769-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CORY MERIL SMITH
Title or Position: DENTIST
Credential: DMD
Phone: 503-476-5512