Provider Demographics
NPI:1922173699
Name:SMITH, BRIAN W (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 S 3000 E STE 330
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6953
Mailing Address - Country:US
Mailing Address - Phone:801-943-5443
Mailing Address - Fax:
Practice Address - Street 1:6360 S 3000 E STE 330
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6953
Practice Address - Country:US
Practice Address - Phone:801-943-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140871-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice