Healthcare Provider Details

I. General information

NPI: 1891475596
Provider Name (Legal Business Name): BRILLIANT SMILES LAKELAND PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W HIGHLAND DR
LAKELAND FL
33813-1543
US

IV. Provider business mailing address

320 W HIGHLAND DR
LAKELAND FL
33813-1543
US

V. Phone/Fax

Practice location:
  • Phone: 863-644-2428
  • Fax: 863-644-6235
Mailing address:
  • Phone: 863-644-2428
  • Fax: 863-644-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSPREET PARMAR
Title or Position: PRESIDENT
Credential: DMD
Phone: 863-644-2428