MEDICARE: RICHARD A. 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)	24060	CA

General Provider Information

NPI Number	:	1306803960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD A. SMITH DDS

Provider Business Mailing Address
First Line	:	1635 DIVISADERO ST
Second Line	:	STE 625, BOX 1821
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 PARNASSUS AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2210
Country	:	US
Telephone Number	:	415-476-1316
Fax Number	:	415-476-6305

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2008

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