MEDICARE: STEPHANIE 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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	D012117	AZ

General Provider Information

NPI Number	:	1043905839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SMITH

Provider Business Mailing Address
First Line	:	7501 E MCDOWELL RD APT 2211
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-3569
Country	:	US
Telephone Number	:	860-808-6829
Fax Number	:

Provider Business Practice Location Address
First Line	:	7342 E THOMAS RD STE 100
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7243
Country	:	US
Telephone Number	:	480-935-2424
Fax Number	:

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

Provider Enumeration Date	:	04/07/2023
Last Update Date	:	04/11/2025

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Directions to “ STEPHANIE SMITH ” Practice Location

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