Individual
DR. JERROLD WAYNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2000 W. 95TH. STREET, CHICAGO, IL 60643-1116
(773) 881-3920
(773) 881-4058
Mailing address
2000 W. 95TH. STREET, CHICAGO, IL 60643-1116
(773) 881-3910
(773) 881-4058
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019016584
IL
1223G0001X
General Practice Dentistry
12010685
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019016584
—
IL
Enumeration date
01/04/2007
Last updated
04/12/2016
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