Provider Demographics
NPI:1720081359
Name:SMITH, TODD S (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 LAKE AVE. S.
Mailing Address - Street 2:P.O. BOX 123
Mailing Address - City:BATTLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56515
Mailing Address - Country:US
Mailing Address - Phone:218-864-5245
Mailing Address - Fax:
Practice Address - Street 1:412 LAKE AVE. S.
Practice Address - Street 2:
Practice Address - City:BATTLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56515
Practice Address - Country:US
Practice Address - Phone:218-864-5245
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDO98341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice