Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 9877 | KY |
NPI | 1831530641 |
---|---|
Provider Name | Dr. Molly Housley Smith |
First Address | Lexington, KY 40503-2903 |
Second Address | Lexington, KY 40503-2903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2013 |
Last Update Date | 18/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100551740 | (05) | KY |