Provider Demographics
NPI:1477546265
Name:SMITH, DENNIS W (DPM)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 E NORTH ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3538
Mailing Address - Country:US
Mailing Address - Phone:219-663-9446
Mailing Address - Fax:219-663-9450
Practice Address - Street 1:1275 E NORTH ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3538
Practice Address - Country:US
Practice Address - Phone:219-663-9446
Practice Address - Fax:219-663-9450
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000765213EP1101X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100147400Medicaid
IN480030945OtherRAILROAD MEDICARE
IN480030946OtherRAILROAD MEDICARE
IN760800FMedicare ID - Type Unspecified
IN480030945OtherRAILROAD MEDICARE
IN628950GMedicare ID - Type Unspecified