Healthcare Provider Details

I. General information

NPI: 1851354906
Provider Name (Legal Business Name): GARY SMAGALSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST
RICHMOND VA
23219-1610
US

IV. Provider business mailing address

521 N 11TH ST
RICHMOND VA
23298-5045
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-4249
  • Fax:
Mailing address:
  • Phone: 804-828-4249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0411000037
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: