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General NPI Number Information
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NPI Number | 1972212934
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Entity Type | Organization
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Legal Business Name | FOREVER BRIGHT DENTAL LLC
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Dates
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Enumeration Date | 11/18/2022
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 6565 N W ST STE 250
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City | PENSACOLA
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State | FL
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Zip | 32505-1720
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Country | US
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Telephone | 850-418-7413
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Fax |
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Provider Business Mailing Address
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Address Line | 6565 N W ST STE 250
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City | PENSACOLA
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State | FL
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Zip | 32505-1720
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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 | OWNER
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Name | BRIAN ESTRADA
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Credential |
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Telephone | 850-418-7413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126900000X
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Taxonomy Name | Dental Laboratory Technician
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License Number |
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License Number State |
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