Provider Demographics
NPI:1942397872
Name:SMITH, BRIAN LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3973 ATLANTA HWY # 78
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3752
Mailing Address - Country:US
Mailing Address - Phone:770-466-3114
Mailing Address - Fax:770-466-3777
Practice Address - Street 1:3973 ATLANTA HWY # 78
Practice Address - Street 2:SUITE 100
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3752
Practice Address - Country:US
Practice Address - Phone:770-466-3114
Practice Address - Fax:770-466-3777
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0124151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice