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General NPI Number Information
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NPI Number | 1598114233
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Entity Type | Organization
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Legal Business Name | BRIGHT SMILES PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 06/03/2016
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Provider Practice Location Address
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Address Line | 196 EVEREST LN UNIT 1
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City | SAINT JOHNS
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State | FL
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Zip | 32259
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Country | US
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Telephone | 904-239-1714
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Fax |
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Provider Business Mailing Address
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Address Line | 196 EVEREST LN UNIT 1
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City | SAINT JOHNS
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State | FL
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Zip | 32259
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Country | US
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Telephone | 904-239-1714
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. BRYAN MATTHEW BRIGHT
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Credential | DMD
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Telephone | 859-433-6146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN21734
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License Number State | FL
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