Provider Demographics
NPI:1548652993
Name:SMITHFIELD FARM DENTURES AND DENTISTRY
Entity type:Organization
Organization Name:SMITHFIELD FARM DENTURES AND DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-582-3300
Mailing Address - Street 1:12066 SMITHFIELD FARM LN
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-2166
Mailing Address - Country:US
Mailing Address - Phone:301-582-3300
Mailing Address - Fax:301-582-0703
Practice Address - Street 1:12066 SMITHFIELD FARM LN
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-2166
Practice Address - Country:US
Practice Address - Phone:301-582-3300
Practice Address - Fax:301-582-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD34591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty