Provider Demographics
NPI:1023170263
Name:SMITH, ALAN T (DMD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:T
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 1:13959 S SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-2453
Mailing Address - Country:US
Mailing Address - Phone:703-815-4242
Mailing Address - Fax:703-815-4242
Practice Address - Street 1:238 BROOKLEY AVE
Practice Address - Street 2:
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20332
Practice Address - Country:US
Practice Address - Phone:202-404-3603
Practice Address - Fax:202-404-1256
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice