Provider Demographics
NPI:1285887075
Name:SMITH, KERI L (DDS)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
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:PO BOX 10567
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-2567
Mailing Address - Country:US
Mailing Address - Phone:503-936-7134
Mailing Address - Fax:
Practice Address - Street 1:1203 WILLAMETTE ST STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5479
Practice Address - Country:US
Practice Address - Phone:503-936-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1083891223G0001X
ORD80901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice