MEDICARE: DR. JEFFREY C. SMITTEN 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	1223G0001X	General Practice Dentistry	024666	NY

General Provider Information

NPI Number	:	1649252107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY C. SMITTEN D.D.S.

Provider Business Mailing Address
First Line	:	601 FRANKLIN AVE
Second Line	:	SUITE 212
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5795
Country	:	US
Telephone Number	:	516-294-0110
Fax Number	:	516-294-0120

Provider Business Practice Location Address
First Line	:	601 FRANKLIN AVE
Second Line	:	SUITE 212
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5795
Country	:	US
Telephone Number	:	516-294-0110
Fax Number	:	516-294-0120

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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