Provider Demographics
NPI:1659718336
Name:SMITH, NEIL LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:LYNN
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 1:118 S. COURT ST.
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882
Mailing Address - Country:US
Mailing Address - Phone:812-268-6054
Mailing Address - Fax:
Practice Address - Street 1:118 S. COURT ST.
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882
Practice Address - Country:US
Practice Address - Phone:812-268-6054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011966A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist