MEDICARE: PAUL FREDLAND SMITH JR. 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30015868	OH

General Provider Information

NPI Number	:	1417976333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL FREDLAND SMITH JR. D.D.S.

Provider Business Mailing Address
First Line	:	3461 WARRENSVILLE CENTER RD
Second Line	:	STE 306
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-5227
Country	:	US
Telephone Number	:	216-751-3800
Fax Number	:	216-751-3801

Provider Business Practice Location Address
First Line	:	20119 FARNSLEIGH RD.
Second Line	:	#207
City	:	SHAKER HTS.
State	:	OH
Zip	:	44122-3613
Country	:	US
Telephone Number	:	216-751-3800
Fax Number	:	216-751-3801

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	10/27/2016

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