MEDICARE: DR. CLEVELAND TRAMMELL SMITH DMD

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	2827	SC

General Provider Information

NPI Number	:	1790947851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLEVELAND TRAMMELL SMITH DMD

Provider Business Mailing Address
First Line	:	1701 SAINT JULIAN PL
Second Line	:	SUITE 204
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2418
Country	:	US
Telephone Number	:	803-771-6393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 SAINT JULIAN PL
Second Line	:	SUITE204
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2418
Country	:	US
Telephone Number	:	803-771-6393
Fax Number	:

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

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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