MEDICARE: DR. DAVID JOSEPH SMOOT 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	791387579924	UT

General Provider Information

NPI Number	:	1508874090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JOSEPH SMOOT DDS

Provider Business Mailing Address
First Line	:	6095 SO 300 E
Second Line	:	#120
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107
Country	:	US
Telephone Number	:	801-264-8504
Fax Number	:	801-264-0226

Provider Business Practice Location Address
First Line	:	6095 SO 300 E
Second Line	:	#120
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107
Country	:	US
Telephone Number	:	801-264-8504
Fax Number	:	801-264-0226

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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