MEDICARE: DR. HEATHER NICOLE 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	DN25520	FL

General Provider Information

NPI Number	:	1639806334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER NICOLE SMITH DMD

Provider Business Mailing Address
First Line	:	10924 CROSS CREEK BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-4034
Country	:	US
Telephone Number	:	617-855-8156
Fax Number	:

Provider Business Practice Location Address
First Line	:	10924 CROSS CREEK BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-4034
Country	:	US
Telephone Number	:	617-855-8156
Fax Number	:

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	03/10/2026

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