Healthcare Provider Details

I. General information

NPI: 1043440589
Provider Name (Legal Business Name): ANDREA LYNN SMITH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 MAIN STREET 105 DARBY SQUARE
ELVERSON PA
19520
US

IV. Provider business mailing address

3528 SAINT LAWRENCE AVE
READING PA
19606-2325
US

V. Phone/Fax

Practice location:
  • Phone: 610-286-1600
  • Fax: 610-779-6162
Mailing address:
  • Phone: 610-779-8181
  • Fax: 610-779-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS037153
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: