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General NPI Number Information
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NPI Number | 1083804702
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Entity Type | Organization
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Legal Business Name | BRENT SMITH, PLLC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 22433 MIDDLEBELT RD
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-3743
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Country | US
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Telephone | 248-476-1900
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Fax | 248-476-8753
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Provider Business Mailing Address
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Address Line | 5576 PINE AIRES DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1349
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Country | US
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Telephone | 586-803-1458
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Fax | 586-977-6084
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENT DAVID SMITH
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Credential | D.O.
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Telephone | 586-803-1548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5101011057
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License Number State | MI
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