Organization
CARL A. SMUDDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL A SMUDDE (DENTIST)
(812) 466-9826
Entity
Organization
Contact information
Practice address
1608 LAFAYETTE AVE, TERRE HAUTE, IN 47804-2021
(812) 466-9826
(812) 466-1720
Mailing address
1608 LAFAYETTE AVE, TERRE HAUTE, IN 47804-2021
(812) 466-9826
(812) 466-1720
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12007519
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100250380A
MEDICAID
IN
Enumeration date
01/26/2011
Last updated
01/26/2011
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