Provider Demographics
NPI:1134016918
Name:SMOTHERS, DANE TERRELL JR
Entity type:Individual
Prefix:MR
First Name:DANE
Middle Name:TERRELL
Last Name:SMOTHERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 WALKER MILL RD
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-5547
Mailing Address - Country:US
Mailing Address - Phone:202-603-0464
Mailing Address - Fax:
Practice Address - Street 1:1116 VARNEY ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4372
Practice Address - Country:US
Practice Address - Phone:202-754-8329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant