MEDICARE: BRIAN K. SMITH, D.D.S., M.D., INC.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	3018374	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144561002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN K. SMITH, D.D.S., M.D., INC.

Provider Business Mailing Address
First Line	:	14701 DETROIT AVE
Second Line	:	SUITE 333
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4109
Country	:	US
Telephone Number	:	216-228-4232
Fax Number	:	216-228-9136

Provider Business Practice Location Address
First Line	:	14701 DETROIT AVE
Second Line	:	SUITE 333
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4109
Country	:	US
Telephone Number	:	216-228-4232
Fax Number	:	216-228-9136

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN K SMITH
Credential	:	D,D,S., M.D.
Telephone Number	:	216-228-4232

Provider Enumeration Date	:	03/01/2013
Last Update Date	:	03/01/2013

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