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DR. MARK WALLACE SMITH DDS

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1699830265

Individual Registrant:
DR. MARK WALLACE SMITH DDS
Gender: M
Not Sole Proprietor

Location and contact information for practice:
7650 EAST STATE ROAD 252  EDINBURGH, IN 46124 US
Tel: 812-526-2026  Fax: 812-526-2844

Contact information for business:
7650 EAST STATE ROAD 252  EDINBURGH, IN 46124 US
Tel: 812-526-2026  Fax: 812-526-2844

Registration Information:
NPI: 1699830265
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
IN7415

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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