Healthcare Provider Details

I. General information

NPI: 1568514479
Provider Name (Legal Business Name): BRENT J SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 E ARAPAHOE RD SUITE 350
CENTENNIAL CO
80122-2387
US

IV. Provider business mailing address

5161 E ARAPAHOE RD SUITE 350
CENTENNIAL CO
80122-2387
US

V. Phone/Fax

Practice location:
  • Phone: 303-741-2211
  • Fax: 303-741-2453
Mailing address:
  • Phone: 303-741-2211
  • Fax: 303-741-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number28765
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: