Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 30.023261 | OH |
Y | 1223D0004X | Dentist Anesthesiologist | 0401416242 | VA |
NPI | 1023329778 |
---|---|
Provider Name | Dr. Nathan Merrill Smith |
First Address | Purcellville, VA 20132-3485 |
Second Address | Purcellville, VA 20132-3485 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2010 |
Last Update Date | 05/12/2018 |