MEDICARE: DAVID W. SMITH, DDS PLLC

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

General Provider Information

NPI Number	:	1669811634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID W. SMITH, DDS PLLC

Provider Business Mailing Address
First Line	:	831 TIMBER CREEK DR
Second Line	:	STE. #1
City	:	CORDOVA
State	:	TN
Zip	:	38018-3108
Country	:	US
Telephone Number	:	901-754-8080
Fax Number	:	901-754-7903

Provider Business Practice Location Address
First Line	:	831 TIMBER CREEK DR
Second Line	:	STE. #1
City	:	CORDOVA
State	:	TN
Zip	:	38018-3108
Country	:	US
Telephone Number	:	901-754-8080
Fax Number	:	901-754-7903

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. DAVID WATTS SMITH
Credential	:	DDS
Telephone Number	:	901-754-8080

Provider Enumeration Date	:	06/22/2013
Last Update Date	:	06/22/2013

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