Provider Demographics
NPI:1598253262
Name:SMITH, BRENDEN LYNN (DMD)
Entity type:Individual
Prefix:MR
First Name:BRENDEN
Middle Name:LYNN
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 1:686 EAST 110 SOUTH
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003
Mailing Address - Country:US
Mailing Address - Phone:801-756-4595
Mailing Address - Fax:801-756-1827
Practice Address - Street 1:686 EAST 110 SOUTH
Practice Address - Street 2:SUITE 102
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003
Practice Address - Country:US
Practice Address - Phone:801-756-4595
Practice Address - Fax:801-756-1827
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD1106122300000X
UT108329731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist