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General NPI Number Information
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NPI Number | 1285811760
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Entity Type | Organization
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Legal Business Name | BRILLIANT SMILES DENTAL GROUP - POTTSTOWN LLC
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Dates
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Enumeration Date | 01/27/2008
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Last Update Date | 06/12/2009
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Provider Practice Location Address
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Address Line | 728 E HIGH ST
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City | POTTSTOWN
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State | PA
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Zip | 19464-5776
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Country | US
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Telephone | 610-323-1633
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Fax |
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Provider Business Mailing Address
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Address Line | 728 E HIGH ST
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City | POTTSTOWN
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State | PA
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Zip | 19464-5776
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Country | US
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Telephone | 610-323-1633
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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. MICHELLE L AITKEN
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Credential | DDS
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Telephone | 610-323-1633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS035966
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License Number State | PA
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