Provider Demographics
NPI:1578672143
Name:DIMICHELE-SMORRA, LAURIE JO (DMD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:JO
Last Name:DIMICHELE-SMORRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3223
Mailing Address - Country:US
Mailing Address - Phone:973-667-2466
Mailing Address - Fax:973-667-9754
Practice Address - Street 1:10 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3223
Practice Address - Country:US
Practice Address - Phone:973-667-2466
Practice Address - Fax:973-667-9754
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD10169851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice