MEDICARE: DAVID PAUL 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	122300000X	Dentist	015451	MI

General Provider Information

NPI Number	:	1013119197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID PAUL SMITH DDS

Provider Business Mailing Address
First Line	:	3403 LAPEER RD
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-2597
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3403 LAPEER RD
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-2597
Country	:	US
Telephone Number	:	810-985-3729
Fax Number	:

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

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	07/08/2007

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