Provider Demographics
NPI:1982039640
Name:SMYRES, DIANA RAMONA (DDS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:RAMONA
Last Name:SMYRES
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 1:4060 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1478
Mailing Address - Country:US
Mailing Address - Phone:614-529-4378
Mailing Address - Fax:
Practice Address - Street 1:4060 WAYNE ST
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1478
Practice Address - Country:US
Practice Address - Phone:614-529-4378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist