Healthcare Provider Details

I. General information

NPI: 1548192768
Provider Name (Legal Business Name): JOSLYNN ROSE SMITH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 N OAKLAND AVE STE 104
DECATUR IL
62526-3179
US

IV. Provider business mailing address

2727 N OAKLAND AVE STE 104
DECATUR IL
62526-3179
US

V. Phone/Fax

Practice location:
  • Phone: 217-875-4555
  • Fax:
Mailing address:
  • Phone: 217-875-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037116
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: