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General NPI Number Information
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NPI Number | 1528879103
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Entity Type | Organization
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Legal Business Name | SMUDDE FAMILY DENTISTRY
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1608 LAFAYETTE AVE
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City | TERRE HAUTE
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State | IN
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Zip | 47804-2021
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Country | US
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Telephone | 812-466-9826
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 LAFAYETTE AVE
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City | TERRE HAUTE
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State | IN
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Zip | 47804-2021
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Country | US
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Telephone | 812-466-9826
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MEREDETH GRAY
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Credential | DDS
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Telephone | 812-466-9826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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