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General NPI Number Information
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NPI Number | 1588898217
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Entity Type | Organization
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Legal Business Name | BRIGHT SMILE PEDIATRIC DENTIST PLLC
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Dates
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Enumeration Date | 05/09/2009
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Last Update Date | 05/09/2009
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Provider Practice Location Address
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Address Line | 3001 ROBIN RIDGE CT
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City | FAIRFAX
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State | VA
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Zip | 22031-2133
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Country | US
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Telephone | 703-462-8412
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Fax |
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Provider Business Mailing Address
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Address Line | 410 PINE ST SE
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City | VIENNA
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State | VA
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Zip | 22180-4861
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. OSCAR ALDO LUNA
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Credential |
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Telephone | 703-462-8412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 0401410972
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License Number State | VA
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