Provider Demographics
NPI:1447581392
Name:SMITH, WAYNE R (DMD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 GLENGARIFF RD.
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3022
Mailing Address - Country:US
Mailing Address - Phone:516-826-8967
Mailing Address - Fax:
Practice Address - Street 1:656 N. WELLWOOD AVE
Practice Address - Street 2:LOUIS LASKY MEMORIAL MEDICAL & DENTAL CENTER
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-225-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042071-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist