Provider Demographics
NPI:1235124637
Name:SMITH, HENRY GARTH (DMD MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:GARTH
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9443
Mailing Address - Country:US
Mailing Address - Phone:270-245-2105
Mailing Address - Fax:270-452-2355
Practice Address - Street 1:1900 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-9443
Practice Address - Country:US
Practice Address - Phone:270-245-2105
Practice Address - Fax:270-452-2355
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV220002086S0122X
KY413402086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100023940Medicaid
KY000000532699OtherBCBS
KY00151021Medicare PIN
KY00280019Medicare PIN
KY7100023940Medicaid