Healthcare Provider Details

I. General information

NPI: 1467547448
Provider Name (Legal Business Name): SMITH & STECKLER, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 LARKIN ROAD SUITE 201
LEXINGTON KY
40503
US

IV. Provider business mailing address

2505 LARKIN ROAD SUITE 201
LEXINGTON KY
40503
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-6009
  • Fax: 859-278-4443
Mailing address:
  • Phone: 859-278-6009
  • Fax: 859-278-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. WALTER HAYWOOD SMITH
Title or Position: PRESIDENT
Credential: DDS
Phone: 859-278-6009