Provider Demographics
NPI:1801925854
Name:SMYKA, STANLEY M (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:M
Last Name:SMYKA
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 1:1208 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2939
Mailing Address - Country:US
Mailing Address - Phone:231-946-6561
Mailing Address - Fax:231-946-7505
Practice Address - Street 1:1208 E 8TH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2939
Practice Address - Country:US
Practice Address - Phone:231-946-6561
Practice Address - Fax:231-946-7505
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI114011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice