Provider Demographics
NPI:1770615437
Name:SMITH, BARBARA JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JEAN
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 1:423 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IA
Mailing Address - Zip Code:52772-1730
Mailing Address - Country:US
Mailing Address - Phone:563-886-2752
Mailing Address - Fax:
Practice Address - Street 1:423 CEDAR ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772-1730
Practice Address - Country:US
Practice Address - Phone:563-886-2752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA070671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1100008Medicaid