Provider Demographics
NPI:1063566594
Name:SMITH, SEAN MARLOW (DDS)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MARLOW
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 W NOB HILL ST SE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5287
Mailing Address - Country:US
Mailing Address - Phone:503-364-0646
Mailing Address - Fax:503-364-3155
Practice Address - Street 1:1855 W NOB HILL ST SE
Practice Address - Street 2:SUITE 220
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5287
Practice Address - Country:US
Practice Address - Phone:503-364-0646
Practice Address - Fax:503-364-3155
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD72731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice