MEDICARE: DR. JONATHAN BRADFORD SMITH 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	3780	SC

General Provider Information

NPI Number	:	1669573812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN BRADFORD SMITH D.D.S.

Provider Business Mailing Address
First Line	:	1120 SPARKLEBERRY LANE EXT
Second Line	:	SUITE B
City	:	COLUMBIA
State	:	SC
Zip	:	29223-7078
Country	:	US
Telephone Number	:	803-462-3662
Fax Number	:	803-462-6865

Provider Business Practice Location Address
First Line	:	1120 SPARKLEBERRY LANE EXT
Second Line	:	SUITE B
City	:	COLUMBIA
State	:	SC
Zip	:	29223-7078
Country	:	US
Telephone Number	:	803-462-3662
Fax Number	:	803-462-6865

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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