Greta R Smidt
Individual provider Active NPI Prosthodontics · Jasper, FL
NPI 1124682497 · NPPES record last updated Jan 23, 2023
Key facts
- NPI
- 1124682497
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prosthodontics 1223P0700X
- License
- 108257 (CA)
- Practice address
- 413 5TH Ave NW
Jasper, FL 32052-7801 - Phone
- (229) 269-5001
- NPI assigned
- Apr 23, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108257 | CA | MD | Prosthodontist |
| DN24543 | FL | MD | Prosthodontist |
| 7282 | LA | MD | Home Health Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7282 | LA | |
| Prosthodontics | 1223P0700X | DN24543 | FL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Prosthodontics | 1223P0700X | 108257 | CA | Yes |
Addresses
Primary practice location
413 5TH Ave NW
Jasper, FL 32052-7801
Mailing address
11936 Darlington Ave Apt 104
Los Angeles, CA 90049-5651
Phone (229) 251-7570
Other providers in Jasper, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.