Individual
DR. BRIAN A SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD,P.C
Contact information
Practice address
1134 SENOIA RD, SUITE A-2, TYRONE, GA 30290-1622
(770) 487-7775
(770) 964-9660
Mailing address
1134 SENOIA RD, SUITE A-2, TYRONE, GA 30290-1622
(770) 487-7775
(770) 964-9660
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12018
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
538925
UNITED CONCORDIA PROVID #
GA
Enumeration date
11/15/2006
Last updated
07/08/2007
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