Provider Demographics
NPI:1831106483
Name:SMITH, AMY LOUISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LOUISE
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:PO BOX 485
Mailing Address - Street 2:330 OTTAWA ST
Mailing Address - City:ELMORE
Mailing Address - State:OH
Mailing Address - Zip Code:43416
Mailing Address - Country:US
Mailing Address - Phone:419-862-1949
Mailing Address - Fax:
Practice Address - Street 1:220 JACKSON ST
Practice Address - Street 2:POB 46
Practice Address - City:ELMORE
Practice Address - State:OH
Practice Address - Zip Code:43416-9593
Practice Address - Country:US
Practice Address - Phone:419-862-2232
Practice Address - Fax:419-862-2311
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-021883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist