Individual
DR. BRIAN ROY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2125 E BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71105-5314
(318) 797-5812
(318) 797-0390
Mailing address
2125 E BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71105-5314
(318) 797-5812
(318) 797-0390
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4752
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1847526
—
LA
01
—
C9163
BLUE CROSS/BLUE SHIELD
LA
05
—
T8B090451
—
TX
Enumeration date
07/24/2006
Last updated
07/08/2007
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