Provider Demographics
NPI:1225185168
Name:SMITH, JOHN DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DALE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 WHIPPLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3034
Mailing Address - Country:US
Mailing Address - Phone:330-492-7889
Mailing Address - Fax:330-492-7966
Practice Address - Street 1:3455 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3034
Practice Address - Country:US
Practice Address - Phone:330-492-7889
Practice Address - Fax:330-492-7966
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-02-04121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice