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NPI Code Detail

MEDICARE: TYSON COURTNEY SMITH DDS

MEDICARE:   TYSON COURTNEY 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
1122300000XDentist2310MT

General Provider Information

NPI Number : 1265464028
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYSON COURTNEY SMITH DDS
Provider Business Mailing Address
First Line : 310 WENDELL AVE
Second Line : SUITE 2
City : LEWISTOWN
State : MT
Zip : 59457-2267
Country : US
Telephone Number : 406-535-6317
Fax Number : 406-535-2089
Provider Business Practice Location Address
First Line : 310 WENDELL AVE
Second Line : SUITE 2
City : LEWISTOWN
State : MT
Zip : 59457-2267
Country : US
Telephone Number : 406-535-6317
Fax Number : 406-535-2089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 09/24/2008

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Directions to “ TYSON COURTNEY SMITH DDS” Practice Location

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