MEDICARE: RED BANK SMILES DENTISTRY, PC

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

General Provider Information

NPI Number	:	1750858122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED BANK SMILES DENTISTRY, PC

Provider Business Mailing Address
First Line	:	PO BOX 920050
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75392-0050
Country	:	US
Telephone Number	:	714-845-8500
Fax Number	:	303-952-0892

Provider Business Practice Location Address
First Line	:	5443 PLATT SPRINGS RD STE F
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-6203
Country	:	US
Telephone Number	:	803-470-5067
Fax Number	:	806-470-5073

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALEXANDRA SCHUTZ
Credential	:	DDS
Telephone Number	:	803-407-5067

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	02/10/2022

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