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General NPI Number Information
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NPI Number | 1275924540
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Entity Type | Organization
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Legal Business Name | SMITH DENTAL ALOHA LLC
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 18635 SW FARMINGTON RD
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City | ALOHA
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State | OR
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Zip | 97007-5612
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Country | US
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Telephone | 503-575-1337
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Fax |
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Provider Business Mailing Address
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Address Line | 620 SE OAK ST STE D
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City | HILLSBORO
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State | OR
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Zip | 97123-4160
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | RYAN SMITH
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Credential | DDS
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Telephone | 503-575-1337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D9728
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License Number State | OR
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