Matthew Smith, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DN24056 Issued in FL

Practice address

15492 Max Leggett Parkway
Suite 2
Jacksonville, FL 32218

Phone

(904) 414-4500

NPI assigned

Jun 29, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 1, 2022 through Nov 1, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Austinbluffs Dental Prof. LLC

  • General Practice Dentistry
  • Colorado Springs, CO
  • NPI 1427360254
  NPD (past)

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1558743328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15492 MAX LEGGETT PARKWAY",
            "address_2": "SUITE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32218",
            "telephone_number": "904-414-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15492 MAX LEGGETT PARKWAY",
            "address_2": "SUITE 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32218",
            "telephone_number": "904-414-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MATTHEW",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-29",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "DEN.00202550",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "DN24056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Anthony Smith, M.D.
• Mark Robert Smith, PT
• Mary Smith, FNP
• Mary D Smith, CNA CERTIFICATION
• Mary Olivia Smith, DO
• Matthew Lamar Smith, DDS
• Matthew Thomas Smith, DO
• Matthew Thomas Smith, DPT
• Meghan Smith, ATC
• Melana Andreu Smith, R.N.

• Orthodontics and Dentofacial Orthopedics Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.