Provider Demographics
NPI:1992915557
Name:SMITH, RICHARD M
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
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 1:1497 FADLEY RD
Mailing Address - Street 2:
Mailing Address - City:WEYERS CAVE
Mailing Address - State:VA
Mailing Address - Zip Code:24486-2025
Mailing Address - Country:US
Mailing Address - Phone:540-234-8381
Mailing Address - Fax:540-828-6667
Practice Address - Street 1:100 PARKSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812
Practice Address - Country:US
Practice Address - Phone:540-828-3518
Practice Address - Fax:540-828-6667
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA45761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice