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General NPI Number Information
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NPI Number | 1629380605
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Entity Type | Organization
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Legal Business Name | BRIGHT SMILES DENTAL PC
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Dates
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Enumeration Date | 07/07/2010
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 1912 W PECAN ST STE A103
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-3561
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Country | US
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Telephone | 512-989-3200
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Fax | 512-989-3201
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Provider Business Mailing Address
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Address Line | 1912 W PECAN ST STE A103
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-3561
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Country | US
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Telephone | 512-989-3200
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Fax | 512-989-3201
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Authorized Official
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Title or Position | DIRECTOR/DENTIST
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Name | DR. ROBERT K HENDRICKS JR.
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Credential | DDS
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Telephone | 512-989-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22805
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License Number State | TX
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