Provider Demographics
NPI:1194522003
Name:SMITH, DOROTHY J
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4841 SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3027
Mailing Address - Country:US
Mailing Address - Phone:402-319-2898
Mailing Address - Fax:
Practice Address - Street 1:4841 SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3027
Practice Address - Country:US
Practice Address - Phone:402-319-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor