Provider Demographics
NPI:1043383367
Name:SMITH, BRICE LANCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRICE
Middle Name:LANCE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 E 67TH ST
Mailing Address - Street 2:STE 212
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-4943
Mailing Address - Country:US
Mailing Address - Phone:918-494-9070
Mailing Address - Fax:918-494-9051
Practice Address - Street 1:4606 E 67TH ST
Practice Address - Street 2:STE 212
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-4943
Practice Address - Country:US
Practice Address - Phone:918-494-9070
Practice Address - Fax:918-494-9051
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice