MEDICARE: DENNIS E SMITH DDS PC

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	5128	OK

General Provider Information

NPI Number	:	1619147816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENNIS E SMITH DDS PC

Provider Business Mailing Address
First Line	:	5620 S MEMORIAL DR
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-9016
Country	:	US
Telephone Number	:	918-664-8156
Fax Number	:	918-664-6344

Provider Business Practice Location Address
First Line	:	5620 S MEMORIAL DR
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-9016
Country	:	US
Telephone Number	:	918-664-8156
Fax Number	:	918-664-6344

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. DENNIS EDWARD SMITH II
Credential	:	DDS
Telephone Number	:	918-664-8156

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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