Provider Demographics
NPI:1548697766
Name:MARY KREMPASKY SMITH, DDS, PLLC
Entity type:Organization
Organization Name:MARY KREMPASKY SMITH, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KREMPASKY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-325-0233
Mailing Address - Street 1:6817 N CEDAR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4277
Mailing Address - Country:US
Mailing Address - Phone:509-325-0233
Mailing Address - Fax:509-325-7635
Practice Address - Street 1:6817 N CEDAR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4277
Practice Address - Country:US
Practice Address - Phone:509-325-0233
Practice Address - Fax:509-325-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5759122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5060504Medicaid