Provider Demographics
NPI:1073807574
Name:SMYDA, JOLANTA (DDS)
Entity type:Individual
Prefix:DR
First Name:JOLANTA
Middle Name:
Last Name:SMYDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N COUNTY ROAD 1660
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-9334
Mailing Address - Country:US
Mailing Address - Phone:313-445-2958
Mailing Address - Fax:
Practice Address - Street 1:4101 84TH ST
Practice Address - Street 2:STE C
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1950
Practice Address - Country:US
Practice Address - Phone:806-698-6684
Practice Address - Fax:806-698-1444
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice