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General NPI Number Information
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NPI Number | 1235346594
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Entity Type | Individual
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Provider Name | JUSTIN RICHARD SMITH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 3710 168TH ST NE SUITE B-105
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City | ARLINGTON
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State | WA
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Zip | 98223-8461
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Country | US
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Telephone | 360-657-1650
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Fax | 360-657-1502
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Provider Business Mailing Address
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Address Line | 360 ALDER ST
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City | CAMANO ISLAND
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State | WA
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Zip | 98282-8672
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Country | US
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Telephone | 360-657-1650
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Fax | 360-657-1502
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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 | 19026756
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE 10914
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License Number State | WA
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