Provider Demographics
NPI:1821018870
Name:SMITH, LINDA WARREN (DDS)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:WARREN
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 1:2922 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-1716
Mailing Address - Country:US
Mailing Address - Phone:304-675-6012
Mailing Address - Fax:304-674-1146
Practice Address - Street 1:2922 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1716
Practice Address - Country:US
Practice Address - Phone:304-675-6012
Practice Address - Fax:304-675-1146
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV2791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist