MEDICARE: DR. DALE CAMPION SMITH D.D.S.

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	7606	FL

General Provider Information

NPI Number	:	1821171513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE CAMPION SMITH D.D.S.

Provider Business Mailing Address
First Line	:	224 SE 23RD AVE
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7620
Country	:	US
Telephone Number	:	561-737-2005
Fax Number	:	561-737-5859

Provider Business Practice Location Address
First Line	:	224 SE 23RD AVE
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-7620
Country	:	US
Telephone Number	:	561-737-2005
Fax Number	:	561-737-5859

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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