Provider Demographics
NPI:1336719137
Name:MICHAEL B SMITH DDS LLC
Entity Type:Organization
Organization Name:MICHAEL B SMITH DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PANEPINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-392-6057
Mailing Address - Street 1:250 OCHSNER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5257
Mailing Address - Country:US
Mailing Address - Phone:504-392-6057
Mailing Address - Fax:504-391-2429
Practice Address - Street 1:250 OCHSNER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5257
Practice Address - Country:US
Practice Address - Phone:504-392-6057
Practice Address - Fax:504-391-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1700015054OtherINDIVIDUAL NPI