MEDICARE: UNITED ORTHODONTICS OF LAS CRUCES 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	23677	TX

General Provider Information

NPI Number	:	1285070227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED ORTHODONTICS OF LAS CRUCES PLLC

Provider Business Mailing Address
First Line	:	920 N TELSHOR BLVD
Second Line	:	STE E
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8277
Country	:	US
Telephone Number	:	575-521-0900
Fax Number	:	575-522-0154

Provider Business Practice Location Address
First Line	:	17503 LA CANTERA PKWY
Second Line	:	STE104-496
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-8207
Country	:	US
Telephone Number	:	210-561-2400
Fax Number	:	210-561-2400

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	DR. ASHLEY SMITH
Credential	:	D.D.S.
Telephone Number	:	361-442-4902

Provider Enumeration Date	:	05/17/2013
Last Update Date	:	06/10/2013

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