Provider Demographics
NPI:1174771125
Name:ERIC J SMITH DDS, PC
Entity type:Organization
Organization Name:ERIC J SMITH DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-297-7737
Mailing Address - Street 1:4860 RUCKER RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-5281
Mailing Address - Country:US
Mailing Address - Phone:540-297-7737
Mailing Address - Fax:
Practice Address - Street 1:4860 RUCKER RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-5281
Practice Address - Country:US
Practice Address - Phone:540-297-7737
Practice Address - Fax:540-297-5819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty