Provider Demographics
NPI:1942426275
Name:SMITH, MIRANDA WHYLLY (DDS)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:WHYLLY
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:RHODA
Other - Last Name:WHYLLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:120 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2125
Mailing Address - Country:US
Mailing Address - Phone:717-248-6004
Mailing Address - Fax:
Practice Address - Street 1:120 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2125
Practice Address - Country:US
Practice Address - Phone:717-248-6004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030450L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075275400Medicaid