Provider Demographics
NPI:1235222498
Name:SMITH, CYNTHIA ANN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 EL DORADO CT
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-9348
Mailing Address - Country:US
Mailing Address - Phone:815-467-2012
Mailing Address - Fax:
Practice Address - Street 1:5TH & ROSSEVELT RD.
Practice Address - Street 2:BLDG. 200 C129
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-2332
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist