MEDICARE: BEN M SMITH DMD 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	NM1575	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295849792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEN M SMITH DMD PC

Provider Business Mailing Address
First Line	:	PO BOX 8244
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88202-8244
Country	:	US
Telephone Number	:	575-624-2095
Fax Number	:	575-627-5721

Provider Business Practice Location Address
First Line	:	207 N UNION AVE STE E
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88201-3068
Country	:	US
Telephone Number	:	575-910-6748
Fax Number	:	575-208-0780

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	BEN M. SMITH
Credential	:	DMD
Telephone Number	:	575-624-2095

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	03/29/2021

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Directions to “BEN M SMITH DMD PC ” Practice Location

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