Healthcare Provider Details

I. General information

NPI: 1255316162
Provider Name (Legal Business Name): BRION SMITH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 RESEARCH BLVD BUILDING 101
ROCKVILLE MD
20850-3125
US

IV. Provider business mailing address

1314 RESEARCH BOULEVARD BUILDING 101
ROCKVILLE MD
20850-3125
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-0124
  • Fax: 301-295-5932
Mailing address:
  • Phone: 301-319-0124
  • Fax: 301-295-5932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number0401006486
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: