=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710096540
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TODD SMITH DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1583 COMMON STREET SUITE 202
-----------------------------------------------------
City | NEW BRAUNFELS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-629-1954
-----------------------------------------------------
Fax | 830-625-3114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1583 COMMON STREET SUITE 202
-----------------------------------------------------
City | NEW BRAUNFELS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-629-1954
-----------------------------------------------------
Fax | 830-625-3114
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MRS. LINDA LABOUNTY SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 830-629-1954
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D16539
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------