Individual
DR. BRIAN KEITH SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS MD
Contact information
Practice address
14701 DETROIT AVE, #333, LAKEWOOD, OH 44107-4115
(216) 228-4232
(216) 228-9136
Mailing address
14701 DETROIT AVE, #333, LAKEWOOD, OH 44107-4115
(216) 228-4232
(216) 228-9136
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
30018374
OH
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
35067574S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000141822
ANTHEM BCBS
OH
05
—
0811545
—
OH
01
—
150972
CIGNA
OH
01
—
605876
COMPDENT
OH
Enumeration date
10/20/2005
Last updated
01/28/2020
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