Provider Demographics
NPI:1386845444
Name:SMYTH, MARTHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:SMYTH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E GRANADA BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6634
Mailing Address - Country:US
Mailing Address - Phone:386-677-6424
Mailing Address - Fax:
Practice Address - Street 1:115 E GRANADA BLVD STE 11
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6634
Practice Address - Country:US
Practice Address - Phone:386-677-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL125551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice