MEDICARE: DAVID A SMITH DDS FAGD

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	17180	CA

General Provider Information

NPI Number	:	1821017872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A SMITH DDS FAGD

Provider Business Mailing Address
First Line	:	5573 SANDBURG AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122
Country	:	US
Telephone Number	:	858-450-9222
Fax Number	:	858-453-2110

Provider Business Practice Location Address
First Line	:	5573 SANDBURG AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122
Country	:	US
Telephone Number	:	858-450-9222
Fax Number	:	858-453-2110

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/22/2008

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