MEDICARE: DR. LANNY LEE SMITH II 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	122300000X	Dentist	CO7185	CO

General Provider Information

NPI Number	:	1023138344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANNY LEE SMITH II DDS

Provider Business Mailing Address
First Line	:	2160 HOLLOW BROOK DRIVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1444
Country	:	US
Telephone Number	:	719-633-0049
Fax Number	:	719-635-2315

Provider Business Practice Location Address
First Line	:	2160 HOLLOW BROOK DRIVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1444
Country	:	US
Telephone Number	:	719-633-0049
Fax Number	:	719-635-2315

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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