Provider Demographics
NPI:1770784217
Name:SMITH, DIANE LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LYNN
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 1:171 S HIGHPOINT DR
Mailing Address - Street 2:#205
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4908
Mailing Address - Country:US
Mailing Address - Phone:815-524-5342
Mailing Address - Fax:
Practice Address - Street 1:2357 HASSELL RD
Practice Address - Street 2:STE 208
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-310-9600
Practice Address - Fax:847-310-9631
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice