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General NPI Number Information
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NPI Number | 1710036819
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Entity Type | Individual
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Provider Name | LARYSA SMITH DDS
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Gender | Female
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 11435 W PALMETTO PARK RD STE I
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City | BOCA RATON
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State | FL
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Zip | 33428-2630
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Country | US
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Telephone | 561-482-6446
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Fax | 561-852-8743
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Provider Business Mailing Address
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Address Line | 11435 W PALMETTO PARK RD STE I
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City | BOCA RATON
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State | FL
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Zip | 33428-2630
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Country | US
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Telephone | 561-482-6446
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Fax | 561-852-8743
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN17497
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License Number State | FL
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