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General NPI Number Information
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NPI Number | 1891886792
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Entity Type | Organization
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Legal Business Name | BRIGHTER SMILES INC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3926 3RD AVE S
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City | GREAT FALLS
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State | MT
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Zip | 59405
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Country | US
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Telephone | 406-761-2151
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Fax | 406-761-1988
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Provider Business Mailing Address
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Address Line | 3926 3RD AVE S
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City | GREAT FALLS
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State | MT
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Zip | 59405
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Country | US
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Telephone | 406-761-2151
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Fax | 406-761-1988
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | ROBERT A BRONECKO
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Credential | DDS
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Telephone | 406-761-2151
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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 | MT1898
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License Number State | MT
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