MEDICARE: SARAH JOSEFINA 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1184234627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAH JOSEFINA SMITH, DDS

Provider Business Mailing Address
First Line	:	PO BOX 10797
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-0797
Country	:	US
Telephone Number	:	585-342-7902
Fax Number	:

Provider Business Practice Location Address
First Line	:	1299 PORTLAND AVE STE 4
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2727
Country	:	US
Telephone Number	:	585-342-7902
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SARAH JOSEFINA SMITH
Credential	:	DDS
Telephone Number	:	585-342-7902

Provider Enumeration Date	:	08/07/2020
Last Update Date	:	08/10/2020

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