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NPI Code Detail

MEDICARE: DR. MICHAEL T SMITH D.M.D.

MEDICARE: DR. MICHAEL T SMITH D.M.D.
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
1122300000XDentist019028833IL

General Provider Information

NPI Number : 1649551748
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL T SMITH D.M.D.
Provider Business Mailing Address
First Line : 16 N JACKSON ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1425
Country : US
Telephone Number : 618-235-5141
Fax Number : 618-235-2155
Provider Business Practice Location Address
First Line : 16 N JACKSON ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1425
Country : US
Telephone Number : 618-235-5141
Fax Number : 618-235-2155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2011
Last Update Date : 02/28/2021

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