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General NPI Number Information
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NPI Number | 1366822710
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Entity Type | Organization
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Legal Business Name | A BRIGHTER SMILE
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Dates
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Enumeration Date | 06/01/2015
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 385 BERT KOUNS LOOP SUITE 700
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City | SHREVEPORT
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State | LA
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Zip | 71106-8158
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Country | US
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Telephone | 318-688-9330
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Fax | 318-688-1183
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Provider Business Mailing Address
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Address Line | 385 BERT KOUNS LOOP SUITE 700
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City | SHREVEPORT
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State | LA
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Zip | 71106-8158
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Country | US
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Telephone | 318-688-9330
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Fax | 318-688-1183
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Authorized Official
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Title or Position | INSURANCE CLERK
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Name | INGER WHITTINGTON
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Credential |
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Telephone | 318-688-9330
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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 | 5831
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License Number State | LA
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