MEDICARE: DR. HENRY VERN 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
1	1223G0001X	General Practice Dentistry	HD105429	CO

General Provider Information

NPI Number	:	1396743233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY VERN SMITH DDS

Provider Business Mailing Address
First Line	:	5657 S HIMALAYA ST
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-5310
Country	:	US
Telephone Number	:	303-690-5658
Fax Number	:	303-690-5691

Provider Business Practice Location Address
First Line	:	5657 S HIMALAYA ST
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-5310
Country	:	US
Telephone Number	:	303-690-5658
Fax Number	:	303-690-5691

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/08/2007

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