MEDICARE: DR. DENNIS H SMITH

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	1223P0700X	Prosthodontics	4454	WA

General Provider Information

NPI Number	:	1992877021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS H SMITH

Provider Business Mailing Address
First Line	:	1200 116TH AVE NE STE A
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3802
Country	:	US
Telephone Number	:	425-453-1117
Fax Number	:	425-462-1878

Provider Business Practice Location Address
First Line	:	1200 116TH AVE NE STE A
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3802
Country	:	US
Telephone Number	:	425-453-1117
Fax Number	:	425-462-1878

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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