Provider Demographics
NPI:1245296821
Name:SMITH DENTAL CLINIC LLC
Entity type:Organization
Organization Name:SMITH DENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-285-6531
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:LARNEL
Mailing Address - State:KS
Mailing Address - Zip Code:67550
Mailing Address - Country:US
Mailing Address - Phone:620-285-6531
Mailing Address - Fax:620-285-6573
Practice Address - Street 1:706 FT LARNEL AVE
Practice Address - Street 2:
Practice Address - City:LARNEL
Practice Address - State:KS
Practice Address - Zip Code:67550
Practice Address - Country:US
Practice Address - Phone:620-285-6531
Practice Address - Fax:620-285-6573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty