MEDICARE: DOUGLAS L SMITH, DDS, PC

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	261QD0000X	Dental Clinic/Center	3608	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ3608	OTHER	AZ	DENTAL LICENSE

General Provider Information

NPI Number	:	1215139563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS L SMITH, DDS, PC

Provider Business Mailing Address
First Line	:	1467 W ELLIOT RD
Second Line	:	SUITE 101
City	:	GILBERT
State	:	AZ
Zip	:	85233-5167
Country	:	US
Telephone Number	:	482-926-4498
Fax Number	:

Provider Business Practice Location Address
First Line	:	1467 W ELLIOT RD
Second Line	:	SUITE 101
City	:	GILBERT
State	:	AZ
Zip	:	85233-5167
Country	:	US
Telephone Number	:	482-926-4498
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DOUGLAS L SMITH
Credential	:	DDS
Telephone Number	:	480-926-4498

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	08/22/2020

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