Provider Demographics
NPI:1376959932
Name:SMITH, BRANDON L (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:L
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 1:738 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4230
Mailing Address - Country:US
Mailing Address - Phone:931-520-8880
Mailing Address - Fax:931-520-8889
Practice Address - Street 1:738 E SPRING ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4230
Practice Address - Country:US
Practice Address - Phone:931-520-8880
Practice Address - Fax:931-520-8889
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS9846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist