Provider Demographics
NPI:1851484976
Name:SMITH, AARON DOUGLAS (DMD)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:DOUGLAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20901 79TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-5325
Mailing Address - Country:US
Mailing Address - Phone:253-875-8135
Mailing Address - Fax:
Practice Address - Street 1:6314 19TH ST W
Practice Address - Street 2:SUITE #21
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6223
Practice Address - Country:US
Practice Address - Phone:253-565-1430
Practice Address - Fax:253-460-6382
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000084811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1370913OtherUNITED CONCORDIA #
WA5039276Medicare ID - Type UnspecifiedDSHS