Individual
LARITA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
6821 S HALSTED ST, CHICAGO, IL 60621-1833
(773) 651-3629
Mailing address
1619 W OLIVE AVE, CHICAGO, IL 60660-4102
(773) 996-8794
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
020009349
IL
Other
Enumeration date
04/03/2017
Last updated
04/03/2017
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