MEDICARE: BRIGHTSMILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	2902014191	MI

General Provider Information

NPI Number	:	1083848311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTSMILES

Provider Business Mailing Address
First Line	:	550 EATON ST
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1124
Country	:	US
Telephone Number	:	248-978-5999
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 EATON ST
Second Line	:
City	:	RIVER ROUGE
State	:	MI
Zip	:	48218-1124
Country	:	US
Telephone Number	:	248-978-5999
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	A M
Credential	:
Telephone Number	:	248-978-5999

Provider Enumeration Date	:	05/14/2009
Last Update Date	:	09/01/2010

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Directions to “BRIGHTSMILES ” Practice Location

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