Provider Demographics
NPI:1538713342
Name:SMITH, JOEL C (DDS)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5722
Mailing Address - Country:US
Mailing Address - Phone:985-237-4588
Mailing Address - Fax:
Practice Address - Street 1:1541 E CLARK ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4100
Practice Address - Country:US
Practice Address - Phone:208-232-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV72611223G0001X
IDD-55821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice