Healthcare Provider Details

I. General information

NPI: 1689892820
Provider Name (Legal Business Name): HAROLD A SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 CASTLE CREEK PARKWAY NORTH DRIVE
INDIANAPOLIS IN
46250-4304
US

IV. Provider business mailing address

5625 CASTLE CREEK PARKWAY NORTH DRIVE
INDIANAPOLIS IN
46250-4304
US

V. Phone/Fax

Practice location:
  • Phone: 317-585-0008
  • Fax:
Mailing address:
  • Phone: 317-585-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12006427
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: