MEDICARE: DR. DENNIS EDWARD SMITH II 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	5128	OK

General Provider Information

NPI Number	:	1992711881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS EDWARD SMITH II D.D.S.

Provider Business Mailing Address
First Line	:	5620 S MEMORIAL DR
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-9016
Country	:	US
Telephone Number	:	918-664-8156
Fax Number	:	918-664-6344

Provider Business Practice Location Address
First Line	:	5620 S MEMORIAL DR
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-9016
Country	:	US
Telephone Number	:	918-664-8156
Fax Number	:	918-664-6344

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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