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General NPI Number Information
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NPI Number | 1053521732
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Entity Type | Organization
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Legal Business Name | BRIGHT DENTAL P.C
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3907 PRINCE ST STE 4H
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City | FLUSHING
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State | NY
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Zip | 11354-5308
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Country | US
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Telephone | 718-961-1628
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Fax |
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Provider Business Mailing Address
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Address Line | 3907 PRINCE ST STE 4H
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City | FLUSHING
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State | NY
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Zip | 11354-5308
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IVY X. WANG
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Credential | D.D.S
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Telephone | 718-961-1628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 049014
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License Number State | NY
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