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General NPI Number Information
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NPI Number | 1568126555
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Entity Type | Organization
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Legal Business Name | BRIGHT DENTAL SOLUTIONS, INC
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Dates
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Enumeration Date | 10/26/2021
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 2501 SW 101ST AVENUE SUITE #107
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City | MIRAMAR
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State | FL
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Zip | 33025-5092
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Country | US
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Telephone | 954-399-8025
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Fax | 954-399-8397
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Provider Business Mailing Address
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Address Line | 2501 SW 101ST AVENUE SUITE #107
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City | MIRAMAR
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State | FL
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Zip | 33025-5092
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Country | US
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Telephone | 954-399-8025
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Fax | 954-399-8397
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELSA GRULLON CORTORREAL
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Credential | DDS
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Telephone | 305-753-2916
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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 |
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License Number State |
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