NPIMap

Organization Active NPI

Kevin J Smith DDS PLLC

  • Dentist
  • Vancouver, WA
National Provider Identifier
1689888158
Registry record updated Apr 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE60171756 Issued in WA
Legal business name
KEVIN J SMITH DDS PLLC
Doing business as
Prairie Dental Care
Practice address
10001 NE 117TH Ave
Vancouver, WA 98662-1504
Phone
(360) 944-9800
NPI assigned
May 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tiffany Smith
Title
Office Manager
Phone
(360) 944-9800

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DE60171756 WA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DE00007532 WA
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DE00010195 WA

Addresses

Primary practice location

10001 NE 117TH Ave
Vancouver, WA 98662-1504

Mailing address

10001 NE 117TH Ave
Vancouver, WA 98662-1504
Phone (360) 944-9800

Other names 1

  • Prairie Dental Care Doing business as

National Provider Directory

National Provider Directory

Locations

10001 NE 117th Ave
Vancouver, WA 98662
Phone (360) 609-9444

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460937600000",
    "number": "1689888158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10001 NE 117TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986621504",
            "telephone_number": "360-944-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10001 NE 117TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986621504",
            "telephone_number": "360-944-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN J SMITH DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2016-04-18",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "360-944-9800",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60171756",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00007532",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010195",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.