# CARL A. SMUDDE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134424930
- **Authorized official:** CARL A SMUDDE (DENTIST)
- **Authorized official phone:** (812) 466-9826

## Contact information

- **Practice address:** 1608 LAFAYETTE AVE, TERRE HAUTE, IN 47804-2021
- **Practice address phone:** (812) 466-9826
- **Practice address fax:** (812) 466-1720
- **Mailing address:** 1608 LAFAYETTE AVE, TERRE HAUTE, IN 47804-2021
- **Mailing address phone:** (812) 466-9826
- **Mailing address fax:** (812) 466-1720

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12007519 | IN | Yes |

## Other

- **Enumeration date:** 01/26/2011
- **Last updated:** 01/26/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 100250380A | MEDICAID | IN |