MEDICARE: DR. MELISSA W. 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	1223G0001X	General Practice Dentistry	9543	NC

General Provider Information

NPI Number	:	1134567142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA W. SMITH D.D.S.

Provider Business Mailing Address
First Line	:	304 E INDEPENDENCE BLVD
Second Line	:	SUITE 200
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-3759
Country	:	US
Telephone Number	:	336-786-5045
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 E INDEPENDENCE BLVD
Second Line	:	SUITE 200
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-3759
Country	:	US
Telephone Number	:	336-786-5045
Fax Number	:

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

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	07/03/2014

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