MEDICARE: KEVIN 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	122300000X	Dentist	203996	CO

General Provider Information

NPI Number	:	1649831546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN SMITH DMD

Provider Business Mailing Address
First Line	:	5657 S HIMALAYA ST STE 270
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-5310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5657 S HIMALAYA ST STE 270
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-5310
Country	:	US
Telephone Number	:	303-907-1333
Fax Number	:

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

Provider Enumeration Date	:	06/22/2019
Last Update Date	:	06/22/2019

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