MEDICARE: DR. PATRICK GLENN SMITH D.D.S.

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	1223G0001X	General Practice Dentistry	2901015731	MI

General Provider Information

NPI Number	:	1063598134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK GLENN SMITH D.D.S.

Provider Business Mailing Address
First Line	:	532 N OLD WOODWARD AVE
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-5375
Country	:	US
Telephone Number	:	248-644-3414
Fax Number	:	248-644-1012

Provider Business Practice Location Address
First Line	:	532 N OLD WOODWARD AVE
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-5375
Country	:	US
Telephone Number	:	248-644-3414
Fax Number	:	248-644-1012

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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