MEDICARE: DR. RICHARD NELSON SMITH DMD

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	1223G0001X	General Practice Dentistry	OR5478	OR
2	1223G0001X	General Practice Dentistry	4329-23	MS

General Provider Information

NPI Number	:	1124038286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD NELSON SMITH DMD

Provider Business Mailing Address
First Line	:	119 LAKEPOINTE DR
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39110-9203
Country	:	US
Telephone Number	:	541-729-4969
Fax Number	:

Provider Business Practice Location Address
First Line	:	989 ELLIS AVE
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39209-6256
Country	:	US
Telephone Number	:	601-354-3557
Fax Number	:

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	04/28/2023

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