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NPI Code Detail

MEDICARE: DR. BRUCE STEWART SMITH D.D.S.

MEDICARE: DR. BRUCE STEWART 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
11223S0112XOral and Maxillofacial Surgery (Dentist)15091TX

General Provider Information

NPI Number : 1417942871
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRUCE STEWART SMITH D.D.S.
Provider Business Mailing Address
First Line : 21216 NORTHWEST FWY STE 370
Second Line :
City : CYPRESS
State : TX
Zip : 77429-4696
Country : US
Telephone Number : 281-469-1911
Fax Number : 281-469-6906
Provider Business Practice Location Address
First Line : 21216 NORTHWEST FWY STE 370
Second Line :
City : CYPRESS
State : TX
Zip : 77429-4696
Country : US
Telephone Number : 281-469-1911
Fax Number : 281-469-6906
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 06/11/2009

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