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General NPI Number Information
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NPI Number | 1790035426
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Entity Type | Organization
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Legal Business Name | JONATHAN D SMART, DMD, PC
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 2342 NW PROFESSIONAL DRIVE
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City | CORVALLIS
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State | OR
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Zip | 97330
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Country | US
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Telephone | 541-757-7708
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Fax | 541-738-7192
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Provider Business Mailing Address
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Address Line | 2342 NW PROFESSIONAL DRIVE
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City | CORVALLIS
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State | OR
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Zip | 97330
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Country | US
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Telephone | 541-757-7708
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Fax | 541-738-7192
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN D. SMART
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Credential | DMD
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Telephone | 541-757-7708
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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 | D8256
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License Number State | OR
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