Provider Demographics
NPI:1972683696
Name:SMITH, JODI S (DMD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 NEWTOWN YARDLEY ROAD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940
Mailing Address - Country:US
Mailing Address - Phone:215-860-6068
Mailing Address - Fax:215-860-0168
Practice Address - Street 1:638 NEWTOWN YARDLEY ROAD
Practice Address - Street 2:SUITE 2C
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940
Practice Address - Country:US
Practice Address - Phone:215-860-6068
Practice Address - Fax:215-860-0168
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026483L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice