Provider Demographics
NPI:1861500944
Name:SMITH, OZZIE E III (DDS)
Entity Type:Individual
Prefix:MR
First Name:OZZIE
Middle Name:E
Last Name:SMITH
Suffix:III
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:PO BOX 288080
Mailing Address - Street 2:9718 S. HALSTED
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628
Mailing Address - Country:US
Mailing Address - Phone:773-233-4100
Mailing Address - Fax:773-233-8542
Practice Address - Street 1:9718 S. HALSTED
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628
Practice Address - Country:US
Practice Address - Phone:773-233-4100
Practice Address - Fax:773-233-8542
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V059250Medicare UPIN
ILK19555Medicare ID - Type Unspecified