Healthcare Provider Details

I. General information

NPI: 1508010042
Provider Name (Legal Business Name): JOHN E SMOLNICKY D. D. S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 THORNAPPLE CIR
VALPARAISO IN
46385-6164
US

IV. Provider business mailing address

1751 THORNAPPLE CIR
VALPARAISO IN
46385-6164
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-1141
  • Fax: 219-923-8873
Mailing address:
  • Phone: 219-464-1141
  • Fax: 219-923-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12008756A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: