Provider Demographics
NPI:1760819643
Name:HIEBERT, SMITH DENTAL GROUP, PC
Entity type:Organization
Organization Name:HIEBERT, SMITH DENTAL GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-646-1463
Mailing Address - Street 1:975 NW SALTZMAN RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5647
Mailing Address - Country:US
Mailing Address - Phone:503-646-1463
Mailing Address - Fax:503-646-0753
Practice Address - Street 1:975 NW SALTZMAN RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5647
Practice Address - Country:US
Practice Address - Phone:503-646-1463
Practice Address - Fax:503-646-0753
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIEBERT, SMITH DENTAL GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental