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General NPI Number Information
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NPI Number | 1144561002
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Entity Type | Organization
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Legal Business Name | BRIAN K. SMITH, D.D.S., M.D., INC.
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Dates
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Enumeration Date | 03/01/2013
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 14701 DETROIT AVE SUITE 333
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City | LAKEWOOD
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State | OH
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Zip | 44107-4109
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Country | US
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Telephone | 216-228-4232
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Fax | 216-228-9136
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Provider Business Mailing Address
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Address Line | 14701 DETROIT AVE SUITE 333
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City | LAKEWOOD
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State | OH
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Zip | 44107-4109
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Country | US
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Telephone | 216-228-4232
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Fax | 216-228-9136
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN K SMITH
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Credential | D,D,S., M.D.
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Telephone | 216-228-4232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 3018374
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License Number State | OH
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