Healthcare Provider Details

I. General information

NPI: 1659418374
Provider Name (Legal Business Name): BRADY KENT SMITH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 05/25/2023
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 N MACARTHUR BLVD SUITE 100
IRVING TX
75038-6416
US

IV. Provider business mailing address

3800 GAYLORD PKWY STE 1190
FRISCO TX
75034-9418
US

V. Phone/Fax

Practice location:
  • Phone: 972-255-3712
  • Fax: 972-255-5693
Mailing address:
  • Phone: 844-409-4657
  • Fax: 214-614-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14695
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: