Healthcare Provider Details

I. General information

NPI: 1720526619
Provider Name (Legal Business Name): CHRISTOPHER JASON SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 CROWN AVE
LANCASTER PA
17601-6322
US

IV. Provider business mailing address

327 BARNFIELD SQ NE
LEESBURG VA
20176-4869
US

V. Phone/Fax

Practice location:
  • Phone: 717-481-7645
  • Fax:
Mailing address:
  • Phone: 661-321-6127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number18388
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401419134
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS042016
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: