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General NPI Number Information
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NPI Number | 1003190661
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Entity Type | Organization
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Legal Business Name | BRIGHTER SMILES FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 09/30/2011
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 947 S LAKE BLVD SUITE A
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City | MAHOPAC
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State | NY
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Zip | 10541-3254
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Country | US
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Telephone | 845-621-2424
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Fax | 845-621-1360
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Provider Business Mailing Address
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Address Line | 947 S LAKE BLVD SUITE A
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City | MAHOPAC
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State | NY
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Zip | 10541-3254
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Country | US
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Telephone | 845-621-2424
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Fax | 845-621-1360
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER SUN LEE
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Credential | D.D.S
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Telephone | 845-621-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 039667-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 053114-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 049023
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License Number State | NY
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