Brian Keith Smith, DDS MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

30018374 Issued in OH

Practice address

14701 Detroit Ave
#333
Lakewood, OH 44107-4115

Phone

(216) 228-4232

Fax

(216) 228-9136

NPI assigned

Oct 20, 2005

Last updated

Jan 28, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 31, 2017 through Jan 31, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brian K. Smith, D.D.S., M.D., Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Lakewood, OH
  • NPI 1144561002
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1831188077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14701 DETROIT AVE",
            "address_2": "#333",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441074115",
            "telephone_number": "216-228-4232",
            "fax_number": "216-228-9136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14701 DETROIT AVE",
            "address_2": "#333",
            "city": "LAKEWOOD",
            "state": "OH",
            "postal_code": "441074115",
            "telephone_number": "216-228-4232",
            "fax_number": "216-228-9136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "BRIAN",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "DDS MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30018374",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "OH",
            "license": "35067574S",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0811545",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "150972",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMPDENT",
            "identifier": "605876",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000141822",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda Gail Sims, CDCA
• Jean Marc Sims
• Mary Kathleen Skoch, MD
• Emily Slusarz
• Kellie A Smiddie, LISW
• Courtney Smith
• Deawna Smith
• Devon Smith, MD
• George Smith, LISW
• John Joseph Smith

• Oral and Maxillofacial Surgery (Dentist) in Lakewood, OH
• Providers in Lakewood, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.