Provider Demographics
NPI:1538310438
Name:DR. AMY L. SMITH DDS.,LLC
Entity Type:Organization
Organization Name:DR. AMY L. SMITH DDS.,LLC
Other - Org Name:ELMORE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-862-2232
Mailing Address - Street 1:220 JACKSON ST
Mailing Address - Street 2:PO BOX 46
Mailing Address - City:ELMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43416-9593
Mailing Address - Country:US
Mailing Address - Phone:419-862-2232
Mailing Address - Fax:419-862-2311
Practice Address - Street 1:220 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ELMORE
Practice Address - State:OH
Practice Address - Zip Code:43416-9593
Practice Address - Country:US
Practice Address - Phone:419-862-2232
Practice Address - Fax:419-862-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21883261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental