MEDICARE: BRADLEY D SMITH DMD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DS029629L	PA

General Provider Information

NPI Number	:	1578646758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY D SMITH DMD

Provider Business Mailing Address
First Line	:	1376 FREEPORT RD
Second Line	:	SUITE 1B
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-3110
Country	:	US
Telephone Number	:	412-963-7760
Fax Number	:	412-967-1030

Provider Business Practice Location Address
First Line	:	1376 FREEPORT RD
Second Line	:	SUITE 1B
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-3110
Country	:	US
Telephone Number	:	412-963-7760
Fax Number	:	412-967-1030

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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