MEDICARE: DR. CHANDLER DIANNE 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	1223G0001X	General Practice Dentistry	39982	TX

General Provider Information

NPI Number	:	1992581672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANDLER DIANNE SMITH DDS

Provider Business Mailing Address
First Line	:	5208 LAKE HIGHLANDS DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-2946
Country	:	US
Telephone Number	:	254-749-7972
Fax Number	:

Provider Business Practice Location Address
First Line	:	2098 N VALLEY MILLS DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-2586
Country	:	US
Telephone Number	:	254-799-9540
Fax Number	:

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

Provider Enumeration Date	:	09/07/2023
Last Update Date	:	03/05/2026

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