Provider Demographics
NPI:1396872123
Name:SMITH, THERESA M (DDS)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:SMITH
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 1:442 MARGO LN
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1460
Mailing Address - Country:US
Mailing Address - Phone:610-725-9696
Mailing Address - Fax:
Practice Address - Street 1:195 W LANCASTER AVE
Practice Address - Street 2:STE 1
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1748
Practice Address - Country:US
Practice Address - Phone:610-296-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026234L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist