MEDICARE: DR. MICHAEL JAMES SMITH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	035261	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023084274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JAMES SMITH DDS

Provider Business Mailing Address
First Line	:	MEDICAL ARTS BUILDING
Second Line	:	91 LAKES ROAD
City	:	MONROE
State	:	NY
Zip	:	10950
Country	:	US
Telephone Number	:	845-782-4220
Fax Number	:	845-783-4846

Provider Business Practice Location Address
First Line	:	91 LAKES RD
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-2613
Country	:	US
Telephone Number	:	845-782-4220
Fax Number	:	845-783-4846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	08/31/2010

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