Healthcare Provider Details

I. General information

NPI: 1295702298
Provider Name (Legal Business Name): LANCE ARON SMAGALSKI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 PORT STEWART
WILLIAMSBURG VA
23188-8420
US

IV. Provider business mailing address

77 HOSPITAL AVE STE 212
NORTH ADAMS MA
01247-2538
US

V. Phone/Fax

Practice location:
  • Phone: 301-793-3410
  • Fax:
Mailing address:
  • Phone: 413-664-4100
  • Fax: 413-663-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number50376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: