Provider Demographics
NPI:1659475713
Name:SMITH, ANGELA BROOKE (DDS)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:BROOKE
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 1:101 CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-2221
Mailing Address - Country:US
Mailing Address - Phone:812-295-4000
Mailing Address - Fax:812-295-4626
Practice Address - Street 1:101 CHARLES STREET
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-2221
Practice Address - Country:US
Practice Address - Phone:812-295-4000
Practice Address - Fax:812-295-4626
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010272A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice