Provider Demographics
NPI:1831341510
Name:SMYTH, ERIC PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PAUL
Last Name:SMYTH
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 1:34779 N LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1112
Mailing Address - Country:US
Mailing Address - Phone:847-231-6084
Mailing Address - Fax:
Practice Address - Street 1:210 BARRON BLVD
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1665
Practice Address - Country:US
Practice Address - Phone:847-276-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist