Provider Demographics
NPI:1902057946
Name:SMYTHE, WILLIAM HOMER III (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HOMER
Last Name:SMYTHE
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5141 DIXIE HWY
Mailing Address - Street 2:SUITE # 202
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1765
Mailing Address - Country:US
Mailing Address - Phone:502-448-2876
Mailing Address - Fax:502-448-2832
Practice Address - Street 1:5141 DIXIE HWY
Practice Address - Street 2:SUITE # 202
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1765
Practice Address - Country:US
Practice Address - Phone:502-448-2876
Practice Address - Fax:502-448-2832
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice