Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5141 | LA |
NPI | 1093881732 |
---|---|
Provider Name | Dr. Tessa M Smith |
First Address | Slidell, LA 70461 |
Second Address | Slidell, LA 70461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1851418 | (05) | LA |