Healthcare Provider Details

I. General information

NPI: 1871578575
Provider Name (Legal Business Name): ROBERT H SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 OLYMPIC DR NW STE B101
GIG HARBOR WA
98335-1767
US

IV. Provider business mailing address

5122 OLYMPIC DR NW STE B101
GIG HARBOR WA
98335-1767
US

V. Phone/Fax

Practice location:
  • Phone: 253-851-5544
  • Fax: 253-851-6561
Mailing address:
  • Phone: 253-851-5544
  • Fax: 253-851-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4673
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: