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General NPI Number Information
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NPI Number | 1063620169
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Entity Type | Individual
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Provider Name | KIM WINONA SMITH DDS, MSD
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Gender | Female
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Dates
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Enumeration Date | 05/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10138 NE 64TH ST APT 37
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City | KIRKLAND
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State | WA
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Zip | 98033-6861
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Country | US
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Telephone | 425-827-1731
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 53
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City | KIRKLAND
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State | WA
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Zip | 98083-0053
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Country | US
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Telephone | 425-827-1731
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DE00006771
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 30-01-8319
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License Number State | OH
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