Provider Demographics
NPI:1720526619
Name:SMITH, CHRISTOPHER JASON
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JASON
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 BARNFIELD SQ NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4869
Mailing Address - Country:US
Mailing Address - Phone:661-321-6127
Mailing Address - Fax:
Practice Address - Street 1:1685 CROWN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6322
Practice Address - Country:US
Practice Address - Phone:717-481-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD183881223S0112X
VA04014191341223S0112X
PADS0420161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery