MEDICARE: DR. ANDREW MARK SMITH D.M.D.

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	5322791-9922	UT

General Provider Information

NPI Number	:	1134263478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW MARK SMITH D.M.D.

Provider Business Mailing Address
First Line	:	6040 FASHION BLVD STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-5415
Country	:	US
Telephone Number	:	801-262-6661
Fax Number	:	801-268-4820

Provider Business Practice Location Address
First Line	:	6040 FASHION BLVD STE 100
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-5415
Country	:	US
Telephone Number	:	801-262-6661
Fax Number	:	801-268-4820

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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