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General NPI Number Information
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NPI Number | 1346456514
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Entity Type | Organization
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Legal Business Name | BRIGHT STAR DENTAL
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2001 E LOHMAN AVE SUITE 121
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City | LAS CRUCES
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State | NM
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Zip | 88001-3167
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Country | US
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Telephone | 505-526-4334
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Fax | 505-526-7863
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Provider Business Mailing Address
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Address Line | 2001 E LOHMAN AVE SUITE 121
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City | LAS CRUCES
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State | NM
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Zip | 88001-3167
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Country | US
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Telephone | 505-526-4334
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Fax | 505-526-7863
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Authorized Official
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Title or Position | CEO
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Name | DR. BRIAN J GILBERT
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Credential | D.D.S.
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Telephone | 505-526-4334
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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 | 1674
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License Number State | NM
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