Provider Demographics
NPI:1962727693
Name:CORY M. SMITH, DMD, L.L.C.
Entity type:Organization
Organization Name:CORY M. SMITH, DMD, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:MERIL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-476-5512
Mailing Address - Street 1:505 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1715
Mailing Address - Country:US
Mailing Address - Phone:503-769-3366
Mailing Address - Fax:503-769-5501
Practice Address - Street 1:505 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1715
Practice Address - Country:US
Practice Address - Phone:503-769-3366
Practice Address - Fax:503-769-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental