MEDICARE: BRIAN M SMITH DMD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS024550L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811985948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN M SMITH DMD MD

Provider Business Mailing Address
First Line	:	101 E LEHIGH AVE
Second Line	:	PM
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1011
Country	:	US
Telephone Number	:	215-707-3613
Fax Number	:	215-707-5405

Provider Business Practice Location Address
First Line	:	101 E LEHIGH AVE
Second Line	:	PM
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-1011
Country	:	US
Telephone Number	:	215-707-3613
Fax Number	:	215-707-5405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	04/25/2016

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