MEDICARE: MRS. SARAH ANN SMITH D.D.S.

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	1223P0221X	Pediatric Dentistry	015923	MO

General Provider Information

NPI Number	:	1083601983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH ANN SMITH D.D.S.

Provider Business Mailing Address
First Line	:	322 JUNGERMANN RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-5350
Country	:	US
Telephone Number	:	636-477-1200
Fax Number	:	636-922-4455

Provider Business Practice Location Address
First Line	:	322 JUNGERMANN RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-5350
Country	:	US
Telephone Number	:	636-477-1200
Fax Number	:	636-922-4455

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/08/2007

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