MEDICARE: DR. JOSIAH MICHAEL 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)	12013141A	IN

General Provider Information

NPI Number	:	1700347168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSIAH MICHAEL SMITH DDS

Provider Business Mailing Address
First Line	:	7845 CARNEGIE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-5792
Country	:	US
Telephone Number	:	260-969-4113
Fax Number	:	260-969-4109

Provider Business Practice Location Address
First Line	:	7845 CARNEGIE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-5792
Country	:	US
Telephone Number	:	260-969-4113
Fax Number	:	260-969-4109

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

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	01/15/2026

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