Provider Demographics
NPI:1508010042
Name:SMOLNICKY, JOHN E (D D S)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:SMOLNICKY
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 THORNAPPLE CIR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6164
Mailing Address - Country:US
Mailing Address - Phone:219-464-1141
Mailing Address - Fax:219-923-8873
Practice Address - Street 1:1751 THORNAPPLE CIR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6164
Practice Address - Country:US
Practice Address - Phone:219-464-1141
Practice Address - Fax:219-923-8873
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008756A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist