Healthcare Provider Details

I. General information

NPI: 1205743291
Provider Name (Legal Business Name): CHAD SMART DDS AND VINCENT O KOKICH JR DMD MSD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 E VALLEY RD STE 105
RENTON WA
98057-4954
US

IV. Provider business mailing address

3900 E VALLEY RD STE 105
RENTON WA
98057-4954
US

V. Phone/Fax

Practice location:
  • Phone: 206-575-1515
  • Fax: 253-752-6392
Mailing address:
  • Phone: 206-575-1515
  • Fax: 253-752-6392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ROSEANNE ANTHONY
Title or Position: HR/FINANCIAL MANAGER
Credential:
Phone: 253-752-3949