MEDICARE: DR. ANDRE XAVIER 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	1223G0001X	General Practice Dentistry	17116	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	112458	OTHER	TX	DENTAL
2	872974	OTHER	TX	DENTAL

General Provider Information

NPI Number	:	1295873925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRE XAVIER SMITH DDS

Provider Business Mailing Address
First Line	:	2606 E HOUSTON ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78202-3227
Country	:	US
Telephone Number	:	210-227-0962
Fax Number	:	210-227-6903

Provider Business Practice Location Address
First Line	:	2606 E HOUSTON ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78202-3227
Country	:	US
Telephone Number	:	210-227-0962
Fax Number	:	210-227-6903

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/09/2007

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