MEDICARE: ASHLEY M. SMITHERMAN, DDS, PLLC

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	1223P0221X	Pediatric Dentistry
2	1223G0001X	General Practice Dentistry	28187	TX

General Provider Information

NPI Number	:	1255794087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHLEY M. SMITHERMAN, DDS, PLLC

Provider Business Mailing Address
First Line	:	4631 AIRPORT BLVD
Second Line	:	STE 120A
City	:	AUSTIN
State	:	TX
Zip	:	78751-3453
Country	:	US
Telephone Number	:	979-777-3258
Fax Number	:

Provider Business Practice Location Address
First Line	:	4631 AIRPORT BLVD
Second Line	:	STE 120A
City	:	AUSTIN
State	:	TX
Zip	:	78751-3453
Country	:	US
Telephone Number	:	979-777-3258
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. ASHLEY SMITHERMAN
Credential	:	DDS
Telephone Number	:	979-777-3258

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	03/30/2016

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