Provider Demographics
NPI:1871352211
Name:SMITH, BRANDON AUSTIN (DMD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:AUSTIN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 W LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FITZWILLIAM
Mailing Address - State:NH
Mailing Address - Zip Code:03447-3505
Mailing Address - Country:US
Mailing Address - Phone:603-933-3622
Mailing Address - Fax:
Practice Address - Street 1:83 W LAKE RD
Practice Address - Street 2:
Practice Address - City:FITZWILLIAM
Practice Address - State:NH
Practice Address - Zip Code:03447-3505
Practice Address - Country:US
Practice Address - Phone:603-933-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program