MEDICARE: AMY L 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	1223G0001X	General Practice Dentistry	HAD69	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831209899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY L SMITH DMD

Provider Business Mailing Address
First Line	:	403 E 11TH ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-3409
Country	:	US
Telephone Number	:	850-747-5599
Fax Number	:	850-872-4131

Provider Business Practice Location Address
First Line	:	479 HIGHWAY 20 E
Second Line	:
City	:	FREEPORT
State	:	FL
Zip	:	32439-3931
Country	:	US
Telephone Number	:	850-880-6568
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	05/09/2023

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