Healthcare Provider Details

I. General information

NPI: 1669577680
Provider Name (Legal Business Name): G RICHARD SMITH DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5692 FAR HILLS AVE SUITE 2
DAYTON OH
45429
US

IV. Provider business mailing address

5692 FAR HILLS AVE SUITE 2
DAYTON OH
45429
US

V. Phone/Fax

Practice location:
  • Phone: 937-434-3916
  • Fax: 937-434-6228
Mailing address:
  • Phone: 937-434-3916
  • Fax: 937-434-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12117
License Number StateOH

VIII. Authorized Official

Name: G RICHARD SMITH
Title or Position: PRESIDENT
Credential: DDS
Phone: 937-434-3916