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NPI Code Detail

MEDICARE: DR. MAURICE EDWARD SMITH DDS

MEDICARE: DR. MAURICE EDWARD 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
11223G0001XGeneral Practice Dentistry101915GA

General Provider Information

NPI Number : 1033279534
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAURICE EDWARD SMITH DDS
Provider Business Mailing Address
First Line : 3870 PEACHTREE INDUSTRIAL BLVD
Second Line : #230
City : DULUTH
State : GA
Zip : 30096-1422
Country : US
Telephone Number : 770-476-9004
Fax Number :
Provider Business Practice Location Address
First Line : 3870 PEACHTREE INDUSTRIAL BLVD
Second Line : #220
City : DULUTH
State : GA
Zip : 30096-1422
Country : US
Telephone Number : 770-476-9004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2006
Last Update Date : 11/27/2013

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