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General NPI Number Information
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NPI Number | 1376154161
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD BRIGHT SMILE SPA PLLC
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 2699 STIRLING RD STE C203
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-6580
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Country | US
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Telephone | 954-374-9993
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Fax |
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Provider Business Mailing Address
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Address Line | 2699 STIRLING RD STE C203
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-6580
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Country | US
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Telephone | 954-374-9993
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SHARY ASK
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Credential | DMD FAGD
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Telephone | 954-374-9993
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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 |
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License Number State |
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