Individual
GRETA R SMIDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
413 5TH AVE NW, JASPER, FL 32052-7801
(229) 269-5001
Mailing address
11936 DARLINGTON AVE APT 104, LOS ANGELES, CA 90049-5651
(229) 251-7570
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7282
LA
1223P0700X
Prosthodontics
Primary
108257
CA
1223P0700X
Prosthodontics
DN24543
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/23/2019
Last updated
01/23/2023
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