MEDICARE: JARED M. SMITH, D.M.D., P.C.

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	8457	CO

General Provider Information

NPI Number	:	1508042482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JARED M. SMITH, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	278 EAGLE DR E
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-9649
Country	:	US
Telephone Number	:	719-269-8917
Fax Number	:

Provider Business Practice Location Address
First Line	:	618 MAIN ST
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-3737
Country	:	US
Telephone Number	:	719-275-0661
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. JARED M SMITH
Credential	:	D.M.D.
Telephone Number	:	719-275-0661

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	01/10/2008

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