Provider Demographics
NPI:1811136013
Name:SMITH, BRIAN PATTERSON (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PATTERSON
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 1:1230 N BROADMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3800
Mailing Address - Country:US
Mailing Address - Phone:316-634-1230
Mailing Address - Fax:
Practice Address - Street 1:1230 N BROADMOOR AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3800
Practice Address - Country:US
Practice Address - Phone:316-634-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist