Provider Demographics
NPI:1851341283
Name:SMITH, MONICA BAEZ (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:BAEZ
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 1:5865 WINDING WAY LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-5298
Mailing Address - Country:US
Mailing Address - Phone:317-465-1847
Mailing Address - Fax:317-549-6001
Practice Address - Street 1:5865 WINDING WAY LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-5298
Practice Address - Country:US
Practice Address - Phone:317-465-1847
Practice Address - Fax:317-549-6001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010708A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice