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General NPI Number Information
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NPI Number | 1538866165
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Entity Type | Organization
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Legal Business Name | BRIGHTSIDE BRACES INC
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 3921 WOODSON'S RESERVE PKWY SUITE 900
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City | SPRING
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State | TX
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Zip | 77386
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Country | US
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Telephone | 832-838-9467
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Fax |
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Provider Business Mailing Address
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Address Line | 3921 WOODSON'S RESERVE PKWY SUITE 900
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City | SPRING
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State | TX
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Zip | 77386
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Country | US
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Telephone | 832-838-9467
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DR. BRANDI ELLYN LEWIS
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Credential | D.D.S.
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Telephone | 207-319-2088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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