MEDICARE: DR. ALLAN MICHAEL 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	122300000X	Dentist	5422	NE

General Provider Information

NPI Number	:	1497752851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN MICHAEL SMITH D.D.S.

Provider Business Mailing Address
First Line	:	217 BELLEVUE BLVD S
Second Line	:
City	:	BELLEVUE
State	:	NE
Zip	:	68005-2442
Country	:	US
Telephone Number	:	402-293-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 LINCOLN RD
Second Line	:
City	:	BELLEVUE
State	:	NE
Zip	:	68005-2361
Country	:	US
Telephone Number	:	402-293-1176
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/02/2023

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