Healthcare Provider Details

I. General information

NPI: 1538310438
Provider Name (Legal Business Name): DR. AMY L. SMITH DDS.,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 JACKSON ST
ELMORE OH
43416-9593
US

IV. Provider business mailing address

220 JACKSON ST PO BOX 46
ELMORE OH
43416-9593
US

V. Phone/Fax

Practice location:
  • Phone: 419-862-2232
  • Fax: 419-862-2311
Mailing address:
  • Phone: 419-862-2232
  • Fax: 419-862-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number21883
License Number StateOH

VIII. Authorized Official

Name: DR. AMY L. SMITH
Title or Position: OWNER
Credential: DDS
Phone: 419-862-2232