Provider Demographics
NPI:1891831731
Name:SMOLCIC, JOHN M (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:SMOLCIC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044
Mailing Address - Country:US
Mailing Address - Phone:717-248-6485
Mailing Address - Fax:
Practice Address - Street 1:73 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044
Practice Address - Country:US
Practice Address - Phone:717-248-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0209090L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist