Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 12006986A | IN |
NPI | 1649391467 |
---|---|
Provider Name | Dr. Glenn Smith |
First Address | Montpelier, IN 47359-1132 |
Second Address | Montpelier, IN 47359-1132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |