Provider Demographics
NPI:1053406041
Name:SMITH, BRYAN SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:SCOTT
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 1:6500 CHAMPION GRANDVIEW WAY APT 27010
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8402
Mailing Address - Country:US
Mailing Address - Phone:512-382-6022
Mailing Address - Fax:
Practice Address - Street 1:7007 HART LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3018
Practice Address - Country:US
Practice Address - Phone:512-345-0399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice