Individual provider Active NPI

David R Smith, DDS

  • Dentist
  • Englewood, FL
National Provider Identifier
1043392624
Registry record updated Nov 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN8016 Issued in FL
Practice address
1861 Placida Rd
Suite 105
Englewood, FL 34223-4961
Phone
(941) 474-9548
Fax
(941) 475-6745
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN8016 FL Primary

Addresses

Primary practice location

1861 Placida Rd
Suite 105
Englewood, FL 34223-4961

Mailing address

1861 Placida Rd
Suite 105
Englewood, FL 34223-4961
Phone (941) 474-9548

Other identifiers 1

IdentifierTypeStateIssuer
DN8016OtherFLMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170222002712 FL Order and Referring Only - DentistPractitioner - Dentist 6901180728

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Networks

  • Freedom Health HMO Network

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478131200000",
    "number": "1043392624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1861 PLACIDA RD",
            "address_2": "SUITE 105",
            "city": "ENGLEWOOD",
            "state": "FL",
            "postal_code": "342234961",
            "telephone_number": "941-474-9548",
            "fax_number": "941-475-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1861 PLACIDA RD",
            "address_2": "SUITE 105",
            "city": "ENGLEWOOD",
            "state": "FL",
            "postal_code": "342234961",
            "telephone_number": "941-474-9548",
            "fax_number": "941-475-6745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DAVID",
        "middle_name": "R",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2016-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN8016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "DN8016",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, FL

Sources for this page

Verify at the official NPI Registry.