MEDICARE: DR. CRAIG LAMONT SMITH D.D.S

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	1223G0001X	General Practice Dentistry	6010	AZ
2	1223G0001X	General Practice Dentistry	5426-015	WI

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	:	1316947690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG LAMONT SMITH D.D.S

Provider Business Mailing Address
First Line	:	1345 W TOWNE SQUARE RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-5047
Country	:	US
Telephone Number	:	262-242-1180
Fax Number	:	262-236-9079

Provider Business Practice Location Address
First Line	:	1345 W TOWNE SQUARE RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-5047
Country	:	US
Telephone Number	:	262-242-1180
Fax Number	:	262-236-9079

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	01/02/2013

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