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General NPI Number Information
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NPI Number | 1194989327
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Entity Type | Organization
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Legal Business Name | LARRY G. SMITH, D.D.S., INC.
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 605 BARNES AVE
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City | ALVA
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State | OK
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Zip | 73717-2231
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Country | US
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Telephone | 580-327-4522
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Fax | 580-327-4525
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Provider Business Mailing Address
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Address Line | 605 BARNES AVE
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City | ALVA
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State | OK
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Zip | 73717-2231
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Country | US
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Telephone | 580-327-4522
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Fax | 580-327-4525
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. LARRY G SMITH
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Credential | D.D.S.
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Telephone | 580-327-4522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4138
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License Number State | OK
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