MEDICARE: A. P. SMITHWICK D.D.S. III PROFESSIONAL LLC

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	1223P0221X	Pediatric Dentistry	DEN00201825	CO

General Provider Information

NPI Number	:	1942673512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A. P. SMITHWICK D.D.S. III PROFESSIONAL LLC

Provider Business Mailing Address
First Line	:	125 INVERNESS DR E STE 300
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-5139
Country	:	US
Telephone Number	:	303-779-5306
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 INVERNESS DR E STE 300
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80112-5139
Country	:	US
Telephone Number	:	303-779-5306
Fax Number	:	303-779-1822

Authorized Official
Title or Position	:	PEDIATRIC DENTIST
Name	:	DR. ALFRED PATRICK SMITHWICK III
Credential	:	DDS
Telephone Number	:	303-779-5306

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	11/04/2015

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