Provider Demographics
NPI:1669592853
Name:SMITH, RAYMICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMICHAEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16466 BERNARDO CENTER DR STE 177
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2522
Mailing Address - Country:US
Mailing Address - Phone:858-675-7007
Mailing Address - Fax:858-675-7447
Practice Address - Street 1:16466 BERNARDO CENTER DR STE 177
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2522
Practice Address - Country:US
Practice Address - Phone:858-675-7007
Practice Address - Fax:858-675-7447
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery