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General NPI Number Information
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NPI Number | 1902964562
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Entity Type | Organization
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Legal Business Name | SMITH FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8211 E 116TH ST SUITE 105
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City | FISHERS
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State | IN
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Zip | 46038-1540
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Country | US
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Telephone | 317-578-1933
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Fax | 317-578-4495
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Provider Business Mailing Address
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Address Line | 8211 E 116TH ST SUITE 105
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City | FISHERS
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State | IN
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Zip | 46038-1540
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Country | US
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Telephone | 317-578-1933
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Fax | 317-578-4495
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Authorized Official
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Title or Position | OFFICE MANAGER SECRETARY OF CORPORA
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Name | MRS. MARGARET A SMITH
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Credential |
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Telephone | 317-578-1933
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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 | 12007179A
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License Number State | IN
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