Provider Demographics
NPI:1306957147
Name:SMUTKA, STEVEN DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:SMUTKA
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 1:4500 SAND POINT WAY NE SUITE 208
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3925
Mailing Address - Country:US
Mailing Address - Phone:206-525-4777
Mailing Address - Fax:206-525-8677
Practice Address - Street 1:4500 SAND POINT WAY NE
Practice Address - Street 2:SUITE 208
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3925
Practice Address - Country:US
Practice Address - Phone:206-525-4777
Practice Address - Fax:206-525-8677
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
439179OtherUNITED CONCORDIA
WA5760400Medicare ID - Type Unspecified