Provider Demographics
NPI:1629074380
Name:SMITH, LARRY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 199
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-0199
Mailing Address - Country:US
Mailing Address - Phone:423-775-1464
Mailing Address - Fax:423-775-1465
Practice Address - Street 1:180 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5939
Practice Address - Country:US
Practice Address - Phone:423-775-1464
Practice Address - Fax:423-775-1465
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS27761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice