Healthcare Provider Details

I. General information

NPI: 1023329778
Provider Name (Legal Business Name): NATHAN MERRILL SMITH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140B PURCELLVILLE GATEWAY DR # 543
PURCELLVILLE VA
20132-3485
US

IV. Provider business mailing address

140B PURCELLVILLE GATEWAY DR # 543
PURCELLVILLE VA
20132-3485
US

V. Phone/Fax

Practice location:
  • Phone: 412-389-9233
  • Fax:
Mailing address:
  • Phone: 412-389-9233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.023261
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number0401416242
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: