Provider Demographics
NPI:1194989327
Name:LARRY G. SMITH, D.D.S., INC.
Entity type:Organization
Organization Name:LARRY G. SMITH, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-327-4522
Mailing Address - Street 1:605 BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-2231
Mailing Address - Country:US
Mailing Address - Phone:580-327-4522
Mailing Address - Fax:580-327-4525
Practice Address - Street 1:605 BARNES AVE
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2231
Practice Address - Country:US
Practice Address - Phone:580-327-4522
Practice Address - Fax:580-327-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty