=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417942871
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRUCE STEWART SMITH D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2005
-----------------------------------------------------
Last Update Date | 06/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21216 NORTHWEST FWY STE 370
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-4696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-469-1911
-----------------------------------------------------
Fax | 281-469-6906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21216 NORTHWEST FWY STE 370
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77429-4696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-469-1911
-----------------------------------------------------
Fax | 281-469-6906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 15091
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------