MEDICARE: SMITH FAMILY DENTAL 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	305R00000X	Preferred Provider Organization	D7760	AZ

General Provider Information

NPI Number	:	1346526233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH FAMILY DENTAL PLLC

Provider Business Mailing Address
First Line	:	3230 E BASELINE RD # 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7114
Country	:	US
Telephone Number	:	602-889-7835
Fax Number	:	602-889-7840

Provider Business Practice Location Address
First Line	:	3230 E BASELINE RD # 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7114
Country	:	US
Telephone Number	:	602-889-7835
Fax Number	:	602-889-7840

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. DAVID D SMITH
Credential	:	DMD
Telephone Number	:	602-889-7835

Provider Enumeration Date	:	10/24/2011
Last Update Date	:	10/24/2011

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