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NPI Code Detail

MEDICARE: DR. KARL ALLEN SMITH DDS, MS

MEDICARE: DR. KARL ALLEN SMITH DDS, MS
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
11223P0300XPeriodontics0401008353VA

General Provider Information

NPI Number : 1487709846
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KARL ALLEN SMITH DDS, MS
Provider Business Mailing Address
First Line : 2500 N VAN DORN ST STE 128
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22302-1601
Country : US
Telephone Number : 703-894-4867
Fax Number : 703-894-4869
Provider Business Practice Location Address
First Line : 2500 N VAN DORN ST STE 128
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22302-1601
Country : US
Telephone Number : 703-894-4867
Fax Number : 703-894-4869
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/08/2007

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