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General NPI Number Information
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NPI Number | 1730595489
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Entity Type | Organization
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Legal Business Name | DR MARK W SMITH DDS LLC
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 7650 E STATE ROAD 252
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City | EDINBURGH
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State | IN
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Zip | 46124-1094
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Country | US
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Telephone | 812-526-2026
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Fax | 812-526-4828
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Provider Business Mailing Address
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Address Line | 7650 E STATE ROAD 252
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City | EDINBURGH
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State | IN
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Zip | 46124-1094
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Country | US
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Telephone | 812-526-2026
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Fax | 812-526-4828
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Authorized Official
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Title or Position | OWNER
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Name | MARK W SMITH
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Credential | D,D,S,
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Telephone | 812-526-2026
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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 |
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License Number State | IN
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