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NPI Code Detail

MEDICARE: DR. SHELBY J. SMITH DDS, MS

MEDICARE: DR. SHELBY J. SMITH DDS, MS
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
11223P0221XPediatric Dentistry38482CA
21223X0400XOrthodontics and Dentofacial Orthopedics Dentistry38482CA

General Provider Information

NPI Number : 1700882784
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHELBY J. SMITH DDS, MS
Provider Business Mailing Address
First Line : 2213 BUCHANAN RD
Second Line : STE 112
City : ANTIOCH
State : CA
Zip : 94509-4265
Country : US
Telephone Number : 925-755-5115
Fax Number : 925-755-5003
Provider Business Practice Location Address
First Line : 2213 BUCHANAN RD
Second Line : STE 112
City : ANTIOCH
State : CA
Zip : 94509-4265
Country : US
Telephone Number : 925-755-5115
Fax Number : 925-755-5003
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 09/11/2025

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