MEDICARE: DR. VINCENT SMITH JR. 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	122300000X	Dentist	1000836	DC
2	122300000X	Dentist	14260	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164420758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT SMITH JR. DDS

Provider Business Mailing Address
First Line	:	6925 WILLOW ST NW
Second Line	:	B-106
City	:	WASHINGTON
State	:	DC
Zip	:	20012-2000
Country	:	US
Telephone Number	:	202-723-8284
Fax Number	:	202-882-1127

Provider Business Practice Location Address
First Line	:	6925 WILLOW STREET
Second Line	:	B-106
City	:	WASHINGTON
State	:	DC
Zip	:	20012
Country	:	US
Telephone Number	:	202-723-8284
Fax Number	:	202-882-1127

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	02/28/2017

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