MEDICARE: DR. WADE DONALD 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	1223P0700X	Prosthodontics	TX 11592	TX

General Provider Information

NPI Number	:	1124146618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WADE DONALD SMITH DDS

Provider Business Mailing Address
First Line	:	4875 FREDERICKSBURG ROAD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3627
Country	:	US
Telephone Number	:	210-366-3333
Fax Number	:	210-366-3335

Provider Business Practice Location Address
First Line	:	4875 FREDERICKSBURG ROAD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3627
Country	:	US
Telephone Number	:	210-366-3333
Fax Number	:	210-366-3335

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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