Provider Demographics
NPI:1689931891
Name:SMITH, EMILIE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMILIE
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:
Other - Last Name:MCCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:320 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-3701
Mailing Address - Country:US
Mailing Address - Phone:630-862-6659
Mailing Address - Fax:785-370-8007
Practice Address - Street 1:320 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3701
Practice Address - Country:US
Practice Address - Phone:630-862-6659
Practice Address - Fax:785-370-8007
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014043200122300000X
KS609121223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice