MEDICARE: DR. DAVID WATTS 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	122300000X	Dentist	DS4557	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DS-4557	OTHER	TN	DENTAL LICENSE

General Provider Information

NPI Number	:	1902979271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WATTS SMITH DDS

Provider Business Mailing Address
First Line	:	831 TIMBER CREEK DR STE 1
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-3108
Country	:	US
Telephone Number	:	901-754-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	831 TIMBER CREEK DR STE 1
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-3108
Country	:	US
Telephone Number	:	901-754-8080
Fax Number	:

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	06/20/2013

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