Jethroe Joseph Smith, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12010325A Issued in IN

Practice address

425 Joliet St
Suite 311
Dyer, IN 46311

Phone

(219) 865-6555

Fax

(219) 865-8842

NPI assigned

Aug 9, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811907280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 JOLIET ST",
            "address_2": "SUITE 311",
            "city": "DYER",
            "state": "IN",
            "postal_code": "46311",
            "telephone_number": "219-865-6555",
            "fax_number": "219-865-8842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 JOLIET ST",
            "address_2": "SUITE 311",
            "city": "DYER",
            "state": "IN",
            "postal_code": "46311",
            "telephone_number": "219-865-6555",
            "fax_number": "219-865-8842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JETHROE",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010325A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elise Frances Slosser, PHARMD, RPH
• Melissa Ann Slotwinski, MOT, OTR/L
• Smile Haus Dental Studio LLC
• Smiles by Doctor a LLC
• C Richard Smith, DO
• Mary Sohl
• Cyrus D Solhkhah, M.D.
• Emma Sorrentino
• Willard C. Spurlock
• St Margaret Mercy Healthcare Centers

• General Practice Dentistry in Dyer, IN
• Providers in Dyer, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.