Healthcare Provider Details

I. General information

NPI: 1356372957
Provider Name (Legal Business Name): JONATHAN JAY SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W HASTINGS RD
SPOKANE WA
99218-2576
US

IV. Provider business mailing address

315 W HASTINGS RD
SPOKANE WA
99218-2576
US

V. Phone/Fax

Practice location:
  • Phone: 509-466-2373
  • Fax: 509-466-4707
Mailing address:
  • Phone: 509-466-2373
  • Fax: 509-466-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD4171
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60311143
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: