Individual
JACOB ROGER SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
416 N 2ND ST, AMITE, LA 70422-2420
(985) 748-4652
(985) 748-7957
Mailing address
416 N 2ND ST, AMITE, LA 70422-2420
(985) 748-4652
(985) 748-7957
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7219
LA
Other
Enumeration date
05/16/2021
Last updated
10/13/2022
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