Healthcare Provider Details

I. General information

NPI: 1033212659
Provider Name (Legal Business Name): LARRY GILMER SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 BARNES ST.
ALVA OK
73717-2231
US

IV. Provider business mailing address

605 BARNES ST.
ALVA OK
73717-2231
US

V. Phone/Fax

Practice location:
  • Phone: 580-327-4522
  • Fax: 580-327-4525
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4138
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: