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General NPI Number Information
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NPI Number | 1023329778
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Entity Type | Individual
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Provider Name | NATHAN MERRILL SMITH DMD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2010
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 140B PURCELLVILLE GATEWAY DR # 543
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City | PURCELLVILLE
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State | VA
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Zip | 20132-3485
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Country | US
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Telephone | 412-389-9233
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Fax |
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Provider Business Mailing Address
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Address Line | 140B PURCELLVILLE GATEWAY DR # 543
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City | PURCELLVILLE
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State | VA
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Zip | 20132-3485
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Country | US
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Telephone | 412-389-9233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.023261
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 0401416242
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License Number State | VA
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