Smith, Brian Roy
Smith, Brian Roy is an individual health care provider with primary practice located at 2125 E Bert Kouns Industrial Loop , Shreveport LA 71105-5314. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Smith, Brian Roy can be contacted via phone (318) 797-5812.Contact Information
Primary practice address
2125 E Bert Kouns Industrial Loop
Shreveport LA 71105-5314
Phone: (318) 797-5812
Fax: (318) 797-0390
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 4752 | Louisiana |
Profile Details
| NPI number | 1639191182 |
|---|---|
| LBN Legal business name | Smith, Brian Roy |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 24th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639191182 | NPPES |
| Louisiana | Other | C9163 | BLUE CROSS/BLUE SHIELD |
| Louisiana | MEDICAID | 1847526 | BLUE CROSS/BLUE SHIELD |
| Louisiana | MEDICAID | T8B090451 | BLUE CROSS/BLUE SHIELD |
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