Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 21406 | CA |
NPI | 1013046093 |
---|---|
Provider Name | Dr. Brian M Smith |
First Address | Bonsall, CA 92003-3624 |
Second Address | Bonsall, CA 92003-3624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |