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General NPI Number Information
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NPI Number | 1568624658
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Entity Type | Individual
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Provider Name | COURTNEY CLEARY SMITH D.M.D
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Gender | Female
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 501 N HADDON AVE STE 7
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City | HADDONFIELD
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State | NJ
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Zip | 08033-1753
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Country | US
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Telephone | 215-858-0442
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Fax |
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Provider Business Mailing Address
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Address Line | 238 JEFFERSON AVE
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City | HADDONFIELD
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State | NJ
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Zip | 08033-3857
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Country | US
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Telephone | 215-858-0442
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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 | 22DI02399600
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License Number State | NJ
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