1235222498 NPI number — MRS. CYNTHIA ANN SMITH R.D.H.

Table of content: DR. FRANCISCO JOGLAR M.D. (NPI 1285607697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235222498 NPI number — MRS. CYNTHIA ANN SMITH R.D.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
CYNTHIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.H.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235222498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 EL DORADO CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINOOKA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60447-9348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-467-2012
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5TH & ROSSEVELT RD.
Provider Second Line Business Practice Location Address:
BLDG. 200 C129
Provider Business Practice Location Address City Name:
HINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-202-8387
Provider Business Practice Location Address Fax Number:
708-202-2332
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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