Provider Demographics
NPI:1710036819
Name:SMITH, LARYSA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARYSA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11435 W PALMETTO PARK RD STE I
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2630
Mailing Address - Country:US
Mailing Address - Phone:561-482-6446
Mailing Address - Fax:561-852-8743
Practice Address - Street 1:11435 W PALMETTO PARK RD STE I
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2630
Practice Address - Country:US
Practice Address - Phone:561-482-6446
Practice Address - Fax:561-852-8743
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN174971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice