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General NPI Number Information
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NPI Number | 1043413735
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Entity Type | Organization
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Legal Business Name | BRIGHTSMILES FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 402 INDEPENDENCE BLVD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-1094
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Country | US
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Telephone | 856-875-8775
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Fax | 856-875-8717
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Provider Business Mailing Address
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Address Line | 402 INDEPENDENCE BLVD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-1094
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Country | US
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Telephone | 856-875-8775
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Fax | 856-875-8717
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOAN S MALCOLM
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Credential | DMD
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Telephone | 856-875-8775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI01975700
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License Number State | NJ
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