Provider Demographics
NPI:1245606177
Name:EAST ALLEN DENE SMITH DDS LLC
Entity Type:Organization
Organization Name:EAST ALLEN DENE SMITH DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:DENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-891-5860
Mailing Address - Street 1:11075 S STATE ST STE 10
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5169
Mailing Address - Country:US
Mailing Address - Phone:513-891-5860
Mailing Address - Fax:513-891-5869
Practice Address - Street 1:9200 MONTGOMERY RD
Practice Address - Street 2:SUITE 1 A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7789
Practice Address - Country:US
Practice Address - Phone:513-891-5860
Practice Address - Fax:513-891-5869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300233131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty