Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DE00009092 | WA |
NPI | 1003035668 |
---|---|
Provider Name | Dr. Chad W Smart |
First Address | Tacoma, WA 98405-1300 |
Second Address | Tacoma, WA 98405-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 03/09/2015 |