Provider Demographics
NPI:1457485583
Name:LARRY V SMITH DDS INC
Entity Type:Organization
Organization Name:LARRY V SMITH DDS INC
Other - Org Name:PACIFIC PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MPH
Authorized Official - Phone:805-544-3434
Mailing Address - Street 1:1231 OSOS ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-544-3434
Mailing Address - Fax:805-544-3443
Practice Address - Street 1:1231 OSOS ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-544-3434
Practice Address - Fax:805-544-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD18270OtherDENTI-CAL