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General NPI Number Information
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NPI Number | 1972055770
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Entity Type | Organization
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Legal Business Name | BRIGHT SMILES DENTAL
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 7205 HANCOCK VILLAGE DR
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City | CHESTERFIELD
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State | VA
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Zip | 23832-2782
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Country | US
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Telephone | 804-332-6310
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Fax | 804-510-0622
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Provider Business Mailing Address
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Address Line | 7205 HANCOCK VILLAGE DR
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City | CHESTERFIELD
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State | VA
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Zip | 23832-2782
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Country | US
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Telephone | 804-332-6310
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Fax | 804-510-0622
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. DAVIS GARDNER
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Credential | DDS
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Telephone | 804-332-6310
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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 | 0401412847
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License Number State | VA
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