Provider Demographics
NPI:1528238086
Name:DR. SANDRA J SMITH
Entity type:Organization
Organization Name:DR. SANDRA J SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-743-9235
Mailing Address - Street 1:PO BOX 37512
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-7512
Mailing Address - Country:US
Mailing Address - Phone:804-743-9235
Mailing Address - Fax:804-743-2946
Practice Address - Street 1:3805 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-2631
Practice Address - Country:US
Practice Address - Phone:804-743-9235
Practice Address - Fax:804-743-2946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA007213S122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty