MEDICARE: DR. WILSON SMITH DDS

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	10359	TX

General Provider Information

NPI Number	:	1700864345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILSON SMITH DDS

Provider Business Mailing Address
First Line	:	3933 SPICEWOOD SPRINGS RD
Second Line	:	STE. E-200
City	:	AUSTIN
State	:	TX
Zip	:	78759-8761
Country	:	US
Telephone Number	:	512-343-1990
Fax Number	:

Provider Business Practice Location Address
First Line	:	3933 SPICEWOOD SPRINGS RD
Second Line	:	STE. E-200
City	:	AUSTIN
State	:	TX
Zip	:	78759-8761
Country	:	US
Telephone Number	:	512-343-1990
Fax Number	:

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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