Healthcare Provider Details

I. General information

NPI: 1477546265
Provider Name (Legal Business Name): DENNIS W SMITH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 E NORTH ST
CROWN POINT IN
46307-3538
US

IV. Provider business mailing address

1275 E NORTH ST
CROWN POINT IN
46307-3538
US

V. Phone/Fax

Practice location:
  • Phone: 219-663-9446
  • Fax: 219-663-9450
Mailing address:
  • Phone: 219-663-9446
  • Fax: 219-663-9450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number07000765
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number07000765
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000765
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: