MEDICARE: DR. BRIAN KEITH SMITH DDS 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)	30018374	OH
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	35067574S	OH

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
2	150972	OTHER	OH	CIGNA
3	605876	OTHER	OH	COMPDENT
4	000000141822	OTHER	OH	ANTHEM BCBS

General Provider Information

NPI Number	:	1831188077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN KEITH SMITH DDS MD

Provider Business Mailing Address
First Line	:	14701 DETROIT AVE
Second Line	:	#333
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4115
Country	:	US
Telephone Number	:	216-228-4232
Fax Number	:	216-228-9136

Provider Business Practice Location Address
First Line	:	14701 DETROIT AVE
Second Line	:	#333
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4115
Country	:	US
Telephone Number	:	216-228-4232
Fax Number	:	216-228-9136

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	01/28/2020

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