Provider Demographics
NPI:1720155187
Name:GARRY L SMITH DDS PC
Entity Type:Organization
Organization Name:GARRY L SMITH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER SCRETARY OF CORP
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-649-3388
Mailing Address - Street 1:1528 MEDICAL ARTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011
Mailing Address - Country:US
Mailing Address - Phone:765-649-3388
Mailing Address - Fax:765-649-5726
Practice Address - Street 1:1528 MEDICAL ARTS BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011
Practice Address - Country:US
Practice Address - Phone:765-649-3388
Practice Address - Fax:765-649-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007179A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty