Provider Demographics
NPI:1346317849
Name:ANGELA B. SMITH, D.D.S.
Entity Type:Organization
Organization Name:ANGELA B. SMITH, D.D.S.
Other - Org Name:FAMILY DENTAL CARE, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-295-4000
Mailing Address - Street 1:101 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-2221
Mailing Address - Country:US
Mailing Address - Phone:812-295-4000
Mailing Address - Fax:812-295-4626
Practice Address - Street 1:101 CHARLES ST
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-2221
Practice Address - Country:US
Practice Address - Phone:812-295-4000
Practice Address - Fax:812-295-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010272A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty