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General NPI Number Information
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NPI Number | 1295315554
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Entity Type | Individual
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Provider Name | JODIE SMITH DMD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 60 SUNRISE HWY # 60
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City | LINDENHURST
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State | NY
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Zip | 11757-2505
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Country | US
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Telephone | 631-296-1124
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Fax |
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Provider Business Mailing Address
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Address Line | 462 FIRST AVENUE
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City | NEW YORK
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State | NY
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Zip | 10016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22D102878500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 062616
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License Number State | NY
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