Provider Demographics
NPI:1487709846
Name:SMITH, KARL ALLEN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N VAN DORN ST STE 128
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1601
Mailing Address - Country:US
Mailing Address - Phone:703-894-4867
Mailing Address - Fax:703-894-4869
Practice Address - Street 1:2500 N VAN DORN ST STE 128
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1601
Practice Address - Country:US
Practice Address - Phone:703-894-4867
Practice Address - Fax:703-894-4869
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010083531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics