Provider Demographics
NPI:1548369630
Name:SMITH, RONALD CRAIG (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:CRAIG
Last Name:SMITH
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 1:1212 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5467
Mailing Address - Country:US
Mailing Address - Phone:515-233-2174
Mailing Address - Fax:515-233-0351
Practice Address - Street 1:1212 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5467
Practice Address - Country:US
Practice Address - Phone:515-233-2174
Practice Address - Fax:515-233-0351
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA056521223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0108878Medicaid