MEDICARE: DR. BRIAN D SMITH D.D.S, M.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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	7547	NC

General Provider Information

NPI Number	:	1447228812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN D SMITH D.D.S, M.S.

Provider Business Mailing Address
First Line	:	1800 DOCTORS DR
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-5057
Country	:	US
Telephone Number	:	919-774-4744
Fax Number	:	919-776-3531

Provider Business Practice Location Address
First Line	:	1800 DOCTORS DR
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-5057
Country	:	US
Telephone Number	:	919-774-4744
Fax Number	:	919-776-3531

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/08/2007

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